Bridgeport Hospital autologous blood donation experience from 1992 to 1996.
The safety of the blood supply, an issue in the 1970s and 1980s, created an increased need to screen the blood supply for HIV-1 and hepatitis C virus infections. The possibility exists that other contamination could again affect the blood supply. This has resulted in the increased use of strategies to minimize the transfusion of allogeneic blood, such as autologous blood predeposit for elective surgical procedures. Many studies indicate, however, that autologous blood donation is overutilized so that half of the blood withdrawn for autologous use is discarded. Cost-effectiveness studies have indicated that autologous blood donation has little benefit compared with many medical procedures, from which one might conclude that the procedure could be eliminated. Alternatively, the benefit could be improved by reducing the wastage of autologous donated blood. This wastage must occur only because of a premise that autologous blood is obtained to ensure avoidance of a homologous transfusion. This results in an amount of blood withdrawn that is more than is used in an uncomplicated procedure. We examined the transfusion requirements in surgical procedures for which there is autologous blood donation to establish the optimum amount of blood to be taken based on expected blood use. The transfusion records of 493 patients who donated blood preoperatively (340 orthopedic, 69 urological and 83 gynecological, in the years 1992 and 1993) were audited to determine the characteristics of the transfusion practices associated with the surgical procedures. The study sample underwent 182 total knee and 123 total hip arthroplasties, 33 laminectomies with fusion and three without, 83 hysterectomies and myomectomies, 59 radical retropubic prostatectomies and 10 nephrectomies and lymph node resections. Data used for evaluation were age, sex, units donated and transfused, predonation hemoglobin concentration, initial and final hemoglobin concentration, surgical procedure and surgical blood loss. The study suggests that autologous predeposit is not indicated for hysterectomies because of the low likelihood of transfusion. Even when a transfusion is likely according to the surgical blood order schedule, predonation is greater than actual use. Use of predonation hemoglobin could facilitate better efficiency of use for procedures where use is anticipated, thereby significantly reducing a wastage near 50 percent.
Department of Pathology, Bridgeport Hospital, CT 06610, USA. lhbernsl@ix.netcom.com
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D001782:Blood Donors; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data*; D003237:Connecticut; D006761:Hospitals; D006801:Humans; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013223:Statistics as Topic / Q000379:methods