[Reduction of homologous blood in elective cardiac surgery with miscellaneous autologous blood transfusion--especially with short-term predonation method].
The efficacy of homologous blood reduction in consecutive elective cardiac surgery by four different autologous transfusion methods was described. One hundred forty patients were divided into five different groups. No autologous blood transfusion in group A (22 cases), intraoperative autotransfusion with Cell Saver in group B (24 cases), additional intraoperative hemodilution method in group C (25 cases), additional preoperative predonation two weeks before operation in group D (15 cases), and predonation one week before operation with recombinant human erythropoietin administration in group E (55 cases) were performed. In group E, the criterion for patient selection of predonation was widely indicated (hemoglobin > 10 g/dl, body weight > 40 kg) and the period of the predonation technique was shorter compared with previous reports. The total homologous blood transfusion volume and the rate of the patients without homologous blood in each groups was 2216 +/- 1888 ml, 14.3% in group A, 2297 +/- 1789 ml, 4.2% in group B, 774 +/- 1043 ml, 36% in group C, 399 +/- 683 ml, 64.3% in group D, 135 +/- 276 ml, and 76.3% in group E, respectively. There were significant differences between group A, B or C and group D (p < 0.01), group A, B or C and group E (p < 0.001), and group D and group E (p < 0.05) with total homologous blood volume and between group A or B and group D (p < 0.01), group A or B and group E (p < 0.001), group B and group C (p < 0.05), and group C and group E (p < 0.01) with the rate of the patients without homologous blood. The reduction of homologous blood volume by patients was 1500 ml by the intraoperative hemodilution method, 370 ml by the preoperative prodonation technique, and 260 ml with predonation using erythropoietin. Ten of the thirteen patient (76.9%) who required homologous blood transfusion in group E had anemia (Hb < 12 g/dl) at preoperative blood pooling or postoperative massive bleeding (total mediastinal drainage > 1000 ml). Elongation of the predonation period before operation or postoperative autotransfusion of mediastinal shed blood and intraoperative aprotinin administration in such patients should be considered to reduce homologous blood transfusion.
Ohuchi
H
H
Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Ibaraki, Japan.
Fukuda
I
I
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001804:Blood Transfusion, Autologous / Q000379:methods*; D006348:Cardiac Surgical Procedures; D017558:Elective Surgical Procedures; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D004921:Erythropoietin