[Home blood transfusion in France: Benefits and development terms]. / Transfusion à domicile : intérêt et conditions de développement dans le contexte français.

OBJECTIVES: Patients with cancers or malignant homeopathies can suffer from chronic anemia and be regularly transfused in hospitals. Most of the time, their performance status is low. Few local structures currently provide blood transfusion services and patients have to go under difficult and costing transportation to the hospital. The objective of this work is to evaluate benefits and development terms of home blood transfusion for patients with chronic anemia and having to get transfused regularly. METHODS: A field investigation-mixing observations and interviews and a literature review were conducted. RESULTS: Home blood transfusion represented a little part of home health care activity. When it was practiced, its organization was heterogeneous: it was sometimes performed by a doctor, sometimes by a nurse. Home blood transfusion was benefic for patients: it was more comfortable and it allowed them to avoid harmful transportation to the hospital. Few adverse events occurred during various experiments, all were mild. Before its revaluation in March 2018, home blood transfusion was not enough funded by National health insurance. Home blood transfusion also suffered from a lack of framework until the publication of recommendations in April 2018. CONCLUSIONS: Lack of a framework and sufficient funding prevented home blood transfusion development until changes that occurred in 2018. Therefore, this activity should develop in years to come. Allowing reducing unnecessary hospitalizations, home blood transfusion fit into French health national strategy.

[Suitability of autologous blood donation before bone marrow donation]. / Pertinence du prélèvement sanguin autologue et de sa transfusion lors d'un don de moelle osseuse.

We assessed the benefit of predeposite autologous blood donation (PAD) before bone marrow (BM) donation on transfusion requirements, haemoglobin concentrations (Hb) and the occurrence of adverse events (AE). We collected data retrospectively from 50 donors of BM with PAD from 2010 to 2014. An autologous transfusion (AT) was given to 50% of the donors (group 1). In the group 2, the products from PAD were not used. The total volume median of marrow harvested was 17.7 mL/k (range 12.3-21.4) in the group 1 and 13.3 mL/k (8.6-22.6) in the group 2. The female ratio was higher in the group 1 (60%) than in the group 2 (16%). Bone marrow harvest led to a decline in Hb (from PAD to first day after BM donation) by 2.9 g/dL (1.5-5.5) in the group 1 and by 3.5 g/dL (1.2-5) in the group 2. The post-harvest Hb (D+1) median was identical in the two groups: 10.9 g/dL (7.6-13.5) in the group 1 versus 11.5 g/dL (9.3-13.4) in the group 2. Six AE were reported in each group. In the group with AE, the median weight was lower: 58 k (50-71) versus 75 k (52-110); and the median total volume of marrow harvested was higher: 20.1 mL/k (9.9-21.4) versus 14.3 mL/k (8.6-22.6). All post-harvest Hb were ≥ 7.6g/dL. This study shows the high loss of Hb after BM donation but not enough to prove a blood transfusion in BM donors with median age of 36 years (16-62) and without comorbidity. The occurrence of AE (25% of BM donors) justifies a careful surveillance after the BM donation. The PAD should not be routinely offered to bone marrow donors.

[Suitability of intraoperative autotransfusion]. / Suivi des techniques de récupération de sang en peropératoire.

This work presents the procedure applied by our hospital to assess the quality and security of intra operative autotransfusion. The suitability of the three following variables has to be constantly assessed: performance of the machines to concentrate and wash collected blood, bacterial contamination of processed blood and rate of adverse events. We note that the procedure is applied with participation of medical and nursing staff. Since its setting-up, we note an amelioration of suitable variables.

[Postoperative autotransfusion and transfusion evaluation in cardiac surgery]. / Autotransfusion postopératoire et bilan transfusionnel en chirurgie cardiaque.

In cardiac surgery, blood retransfusion from the thoracic drainages, though already ancient, still remains controversial either for its quantitative or its qualitative interests. A retrospective study has been conducted, between the 1st january 1992 and the 30th june 1993, over 1.655 consecutive operations. Most of the patients suffered from coronary disease (937) or a valvular disease (605), others had been operated for a combined valvular and coronary revascularization surgery (113). The safety of this technique, guaranteed by strict rules, allowed a "transfusional strategy" which tends to reduce the homologous blood consumption. Twenty-nine percent of all the patients received homologous red cells units and only 23% of the patients operated for a coronary revascularization. This strategy aims to reduce both the risks of blood transfusion and the health cost.

[Evaluation of the cost of autologous erythrocyte concentrates in a hospital]. / Evaluation du coût pour un établissement de santé des concentrés de globules rouges autologues.

This study evaluated the cost of autologous and homologous blood products. The cost effectiveness of the transfusion therapy was not evaluated. To compare the different products, the cost of one gram of transfused haemoglobin was calculated. Acute normovolaemic haemodilution is the most economical technique. Intraoperative autologous transfusion without washing is the most expensive. All blood products from the autologous techniques, except the latter, were less expensive than homologous red cells.