A new risk predictive scoring system of vasovagal reactions in patients with preoperative autologous blood donation.

BACKGROUND AND OBJECTIVES: Vasovagal response (VVR) is the most common adverse reaction during blood donation and it is the main element for the safety of the patients with preoperative autologous blood donation (PABD). Accurate identification high-risk group is of great significance for PABD. Our study aimed to establish a scoring system based on the nomogram to screen the high-risk population and provide evidence for preventing the occurrence of VVRs. MATERIALS AND METHODS: A number of 4829 patients underwent PABD between July 2017 and June 2020 in the first medical center of Chinese PLA Hospital were recruited, 3387 of whom were included in the training group (70 %; 108 VVRs patients vs 3279 Non-VVRs patients), 1442 were included in the validation group (30 %; 46 VVRs patients vs 1396 Non-VVRs patients). The data were analyzed by univariate and multivariate logistic regression. The nomogram of the scoring system was created by using the RMS tool in R software. RESULTS: Seven variables including BMI, hematocrit, pre-phlebotomy heart rate and systolic blood pressure, history of blood donation, age group and primary disease were selected to build the nomogram, which was shown as prediction model. And the score was 0-1 for BMI, 0-2 for hematocrit, systolic blood pressure, heart rate and no blood donation history, 0-10 for age, 0-3 for primary disease. When the total cutoff score was 11, the predictive system for identifying VVRs displayed higher diagnostic accuracy. The area under the curve, specificity, and sensitivity of the training group were 0.942, 82.41 % and 97.17 %, respectively, whereas those of the validation group were 0.836, 78.26 % and 78.15 %, respectively. CONCLUSION: A risk predictive scoring system was successfully developed to identify high-risk VVRs group form PABD patients that performed well.

Investigation on the feasibility of large-volume autologous red blood cells donation: A pilot trial in a small cohort of Chinese.

BACKGROUND: Preoperative autologous blood donation (PAD) is used for elective surgical procedures with a predictable blood loss. But a downward trend in PAD is due to the fact that patients with preoperative whole blood donation or two-unit red cell apheresis cannot avoid receiving allogenic blood during intensive surgery. To improve the clinical application of PAD, this study explores the feasibility of large-volume autologous red blood cells (RBCs) donation by a pilot trial in a small cohort of Chinese. METHODS: This was a single-center, prospective study and 16 male volunteers were enrolled from May to October in 2020. Each volunteer donated 627.25 ± 109.74 mL (mean ± SD) RBC with apheresis machine or manually, and received 800 mg of intravenous iron in four divided doses. Blood pressure, oxygen saturation (SpO2 ), respiratory rate and heart rate were monitored throughout the procedure. The RBC count, hemoglobin (Hb) concentration, hematocrit (Hct), reticulocyte count, erythropoietin (Epo), serum iron, total iron binding capacity (TIBC), transferrin saturation, transferrin, and ferritin were dynamically detected and analyzed before and 8 weeks after blood donation. RESULTS: There was no differences in SpO2 , systolic and diastolic blood pressure before and after blood collection (P ≥ .05). The heart rate and respiratory rate after donation were slightly lower than those before (P < .05). The level of RBC, Hb concentration and Hct fell to a nadir on Day 3 (pre-donation vs post-donation on Day 3: RBC 4.81 ± 0.36*1012 /L vs 3.65 ± 0.31, P < .05; Hb 148.59 ± 11.92 g/L vs 113.19 ± 10.43 g/L, P < .05; Hct 44.08 ± 3.06% vs 33.38 ± 2.57%, P < .05) and recovered to the pre-donation levels at the eighth week post donation (pre-donation vs post-donation at the eighth week: RBC 4.81 ± 0.36*1012 /L vs 4.84 ± 0.34*1012 /L, P ≥ .05; Hb 148.59 ± 11.92 g/L vs 150.91 ± 11.75 g/L, P ≥ .05; Hct 44.08% ± 3.06% vs 43.86 ± 3.06%, P ≥ .05). Epo and the reticulocyte count reached the peak values on Days 1 and 7, respectively (Epo: D0 15.30 ± 7.47 mlU/ML vs D1 43.26 ± 10.52 mlU/ML, P < .05; reticulocyte count: D0 0.07 ± 0.02*109 /L vs D7 0.17 ± 0.04*109 /L, P < .05). The red cell net profits on Day 7, the second, fourth and eighth week postdonation were 160.39 ± 144.33 mL, 387.59 ± 128.74 mL, 530.95 ± 120.37 mL, and 614.18 ± 120.10 mL, and accounted for 27.47% ± 24.70%, 63.75% ± 24.91%, 86.20% ± 22.99%, and 99.20% ± 19.19% of RBC donation, respectively. The levels of serum iron, serum ferritin, and transferrin saturation increased during the first week because of the supplement of intravenous iron, and then gradually decreased and declined to the baseline at the end of the study period at the eighth week. CONCLUSIONS: The large-volume autologous RBCs donation of 600 mL is proved safe in our study. Combination support of normal saline to maintain blood volume and intravenous iron supplementation may ensure the safety and effectiveness of large-volume RBC apheresis.

High-dose intravenous iron supplementation after preoperative autologous blood donation is useful to prevent post-donation/preoperative anemia.

To estimate the effectiveness of high-dose intravenous (IV) iron supplementation for iron deficiency anemia after preoperative autologous blood donation (PAD), 155 donors who visited the donation office of the University of Tokyo Hospital from December 2020 to June 2021 and showed suspected post-donation anemia were analyzed. The participants were treated with high-dose intravenous (IV) iron supplementation (high-dose group, n = 30) or a combination of low-dose IV iron and oral iron supplementation (low-dose group, n = 125). The preoperative hemoglobin (Hb) and Hb decreasing ratios during PAD (ΔHb) were compared between the two groups. Multivariate linear regression analyses were also performed to identify the confounding factors associated with preoperative Hb and ΔHb as well as high-dose IV iron supplementation. Preoperative Hb level was slightly higher in the high-dose group than in the low-dose group (12.1 ±â€¯1.1 vs. 11.9 ±â€¯1.1 g/dL, p = 0.27). ΔHb was significantly higher in the high-dose group than in the low-dose group (3.7 % ± 8.8 % vs. 7.7 % ± 6.5 %, p = 0.011). On the multivariate linear regression analyses, high-dose IV iron supplementation was significantly associated with higher preoperative Hb and lower ΔHb levels (p = 0.021 and 0.017, respectively) as well as the donation available period (period from the first visit to the donation office to the operation) and administration of erythropoiesis-stimulating agents. High-dose IV iron supplementation after PAD will be useful in the treatment of post-donation anemia.

Hematologic evaluation of intraoperative autologous blood collection and allogeneic transfusion in cardiac surgery.

BACKGROUND: Acute normovolemic hemodilution is recommended as a technique to reduce allogeneic red blood cell (RBC) transfusions in cardiac surgery, but its efficacy to reduce non-RBC transfusion has not been consistently demonstrated. We hypothesized that intraoperative large-volume autologous whole blood (AWB) collection and reinfusion improves viscoelastic coagulation parameters. STUDY DESIGN AND METHODS: Prospective observational study of cardiac surgery patients at the University of Maryland Medical Center between December 2017 and August 2019. Rotational thromboelastometry parameters were compared between AWB and control groups (n = 25 in each group) at three time points: T1, baseline; T2, on cardiopulmonary bypass (CPB) after the cross-clamp removal; and T3, 30-60 minutes after protamine administration. The study's primary outcomes were whole blood viscoelastic coagulation parameters that included EXTEM clotting time (CT), FIBTEM amplitude at 10 minutes, and EXTEM amplitude at 10 minutes (EXTEM-A10 ). Chest tube drainage and allogeneic transfusion were secondary outcomes. RESULTS: Reinfusion of AWB after CPB resulted in a significantly shorter EXTEM CT; mean difference, -11.4 seconds (-21.4 to -1.4; P = .03). It also resulted in a greater percentage increase in EXTEM A10 from T2 to T3; mean difference, 7.8% (95% CI, 1.1%-14.5%; P = .02). Statistical significance was not found in 24-hour chest tube drainage. CONCLUSION: Large-volume AWB collection and reinfusion are feasible in selected cardiac surgical patients, and may be associated with prohemostatic effects according to thromboelastometry, warranting further investigation with a prospective randomized study.

Preoperative autologous blood donation for kidney transplant and end-stage renal disease patients: A single-center study.

Although preoperative autologous blood donation (PABD) has many advantages, there has been a decrease in the performance due to a decrease in the residual risk of allogeneic blood transfusion. In allogeneic blood transfusion, anti HLA antibodies and donor-specific antibodies mediate antibody-mediated rejection, which results in graft failure. PABD for anemic patients such as those with end-stage renal disease (ESRD) and a kidney transplant is relatively contraindicated. In this study, we aimed to investigate the characteristics of patients who underwent PABD and elucidate the safety and feasibility of PABD. We performed PABD safely in ten ESRD patients and nine kidney transplant patients and retrospectively analyzed medical records of the hospital. All kidney transplant patients avoided allogeneic blood transfusion, but 4 out of 10 ESRD patients had allogeneic blood transfusion, even if their blood donation volume was larger than those of the kidney transplant patients. It depends on the type of operation; cardiovascular surgery was more common in ESRD patients, and orthopedic surgery was more common in kidney transplant patients. There was profuse bleeding in cardiovascular surgery compared to orthopedic surgery because of longer operation time of the former. Completely avoiding allogeneic blood transfusion in major surgery was rather difficult even if PABD was performed. To prevent the formation of anti- HLA antibodies, PABD would be considered for ESRD patients undergoing kidney transplantation and kidney transplant patients that are potential candidates for secondary kidney transplantation.

Revisiting old practices: More restricted indication of preoperative autologous blood donation in healthy bone marrow donors according to baseline hemoglobin levels.

There is no consensus on the risk-benefit status of preoperative autologous blood donation (PAD) for healthy bone marrow donors and there is concern regarding its impact on the development of pre-surgical anemia. We evaluated the changes in hemoglobin levels related to PAD in 80 bone marrow donors of our institution between 2002 and 2016. Mean Hgb values were compared separately for donors who donated 1 or 2 units, at 3 time-points: before PAD collection, the morning before marrow harvest and soon after harvest. Mean baseline Hgb values did not differ significantly between the 2 groups. After PAD collection, there was a significant drop in Hgb levels for the whole cohort of donors but more pronounced for the group that donated 2 units [1 unit: 12.8(8.9-17.4) × 2 units: 11.55(11.2-12.1), p = 0.045]. However, after marrow harvest, Hgb levels were similar for the 2 groups; 61.2% of all donors required autologous transfusion and none required allogeneic transfusion. Furthermore, baseline Hgb <14.35 g/dL was identified as the sensitive cutoff to predict the need for transfusion after marrow harvest (sensitivity of 52% and specificity of 80.4%, p = 0.001). Thus, our analysis demonstrates the possibility of using hemoglobin thresholds as cutoff points for indication of PAD, tending to a more cost-effective approach. Despite significant declines in Hgb levels after PAD, none of the donors in our cohort required allogeneic transfusion, demonstrating the safety of this procedure. Thus, the indication of PAD remains an option for those who feel insecure despite higher baseline Hgb levels.

Predicting lowest hemoglobin level and risk of blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis.

PURPOSE: The aim of this study was to evaluate the factors associated with timing of lowest hemoglobin (Hb) level and the need for postoperative blood transfusion in posterior spinal fusion for adolescent idiopathic scoliosis. METHODS: We conducted a retrospective review of all adolescent scoliosis patients undergoing posterior spinal fusion at our institution, 2002-2014. Surgery consisted of segmental pedicle screw fixation using multi-level pedicle screws. Blood-saving techniques were used in all patients. Data included Cobb angle, pre- and postoperative Hb levels, preoperative autologous blood donation (PABD), surgery duration, and allogeneic or autologous transfusion. We used linear and logistic regressions for statistical analysis. RESULTS: There were 456 patients (402 female, 54 male), mean age 16 ± 5 years. Lowest Hb was observed on postoperative Days 2 (32.2%) and 3 (33.3%); 45.1% of postoperative transfusions occurred on Day 2. One hundred and eighty-eight (41%) patients who provided PABD had significantly lower preoperative Hb and received more transfusions intraoperatively (22.6% vs. 5.2%) and postoperatively (20% vs. 6.3%) than others. Probability of transfusion increased 49.6 (95% CI 17.40-141.37) times with preoperative Hb < 11 g/dL as compared to preoperative Hb > 14 g/dL. Probability of transfusion increased 4.3- and 9.8-fold when surgery duration exceeded 5 and 6 h, respectively. Probability of transfusion increased 3.3- and 5.3-fold with Cobb angle > 70° and 80°, respectively. CONCLUSIONS: We identified clear patient-specific perioperative parameters that affect risk of perioperative blood transfusion, including Cobb angle, PABD and preoperative Hb. Hb measurement beyond postoperative Day 3 is considered unnecessary unless clinically indicated. These slides can be retrieved under Electronic Supplementary Material.

Pre-operative autologous blood donation and transfusion-related adverse reactions: A 14-year experience at a university hospital.

OBJECTIVE: The objective of this study was to determine the rate of adverse reactions to pre-operative autologous blood donation (PAD) transfusion in a single institution over a 14-year period. STUDY DESIGN AND METHODS: Between January 2003 and December 2016, we investigated adverse reactions to PAD transfusion and compared them with those to allogeneic blood transfusion in Juntendo University Hospital. Adverse reactions were categorized according to the definition proposed by the International Society of Blood Transfusion (ISBT) Working Party on Haemovigilance. RESULTS: A total of 178,014 blood components were transfused during the study period, of which PAD transfusions were 13,653 (8%), whereas allogeneic blood transfusions were 164,361 (92%). The number and rate of adverse reactions to PAD transfusion were 16 and 0.1%, whereas those of allogeneic blood transfusion were 1075 and 0.7%, respectively. The rate of adverse reactions to allogeneic blood transfusions excluding platelet transfusion was 0.3%, being significant (p < 0.01) against PAD transfusion. Among 16 adverse reactions to PAD transfusion, the most common was febrile non-hemolytic transfusion reaction (FNHTR) at 12 (75%), followed by allergic reaction at 4 (25%). The severity of adverse reactions to PAD transfusion was Grade 1 (non-severe) in all cases. With regard to blood component types, 16 adverse reactions involved: 12 cases of whole blood PAD, 2 of frozen PAD, and 2 of autologous fresh-frozen plasma. CONCLUSIONS: Non-severe adverse reactions were observed on PAD transfusion at a rate of 0.1% at our institution.

Balancing Thromboprophylaxis and Bleeding in Total Joint Arthroplasty: Impact of Eliminating Enoxaparin and Predonation and Implementing Pneumatic Compression and Tranexamic Acid.

BACKGROUND: Venous thromboembolic disease (VTED) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) poses substantial risk. Pharmacologic prophylaxis against VTED can cause bleeding, transfusion, and associated complications. The ActiveCare+SFT is a portable, intermittent pneumatic compression device (IPCD), providing equivalent VTED prophylaxis to pharmacologic agents without associated bleeding. Tranexamic acid (TXA) is an antifibrinolytic that reduces blood loss after THA and TKA. Our objective was to measure blood transfusion and VTED after eliminating enoxaparin, introducing an IPCD, eliminating autologous blood transfusion, and administering TXA during primary TKA and THA. METHODS: Four consecutive cohorts of THA and TKA patients were studied. Group A, the historical control, received enoxaparin VTED prophylaxis. Group B received IPCD VTED prophylaxis. Group C received IPCD VTED prophylaxis along with TXA (1 g intravenous at incision and closure). Groups A, B, and C predonated 1 unit of autologous blood. Group D received IPCD VTED prophylaxis, TXA as above, but did not donate blood preoperatively. RESULTS: Seventeen of 50 patients (34%) in Group A, 7 of 47 (14.9%) patients in Group B, 4 of 43 (9.3%) patients in Group C, and 0 of 46 patients in Group D received transfusions. There were no major symptomatic VTED events. CONCLUSION: Using an IPCD and TXA and discontinuing enoxaparin and preoperative autologous blood donation eliminated blood transfusion in primary THA and TKA without any increase in VTED. Using an IPCD instead of enoxaparin, adding TXA, and eliminating preoperative autologous donation each had an incremental dose response effect. This protocol provides effective VTED prophylaxis equivalent to pharmacologic methods and eliminates transfusion risk in the primary THA and TKA population.

Predeposit Autologous Blood Donation in Rh(D)-Negative Pregnant Women: A Single-Center Study.

Objective The primary purpose of this study was to assess the practicability of predeposit autologous blood donation (PABD) in the practice of Rh(D)-negative pregnant women. Materials and Methods A cohort of 405 Rh(D)-negative pregnant women who had a delivery in the comprehensive tertiary hospital in Nanjing was analyzed retrospectively, over 10 years. Results After PABD, 203 women experienced a slight drop in mean hemoglobin of 5.32 ± 0.5 g/L (PABD-associated anemia was not featured in our study). Thirteen women who received allogeneic blood might benefit from PABD practically. Conclusion PABD is applicable for Rh(D)-negative pregnant women, as it ensures the availability of the patient's blood in the event of perinatal hemorrhage, thus minimizing the need for transfusion from external sources. Despite the autologous blood reinfusion of low proportion, PABD could still serve as an alternative when allogeneic blood resources are scarce. However, one challenge in the future is to identify candidates who may benefit most from PABD. Also, more attention is needed to raise awareness of patient blood management. Recommended strategies include early screening and treatment of anemia, hemostasis promotion, and blood loss reduction. Replacement of allogeneic transfusion with autotransfusion could be referred to where feasible. We believe that PABD still has a promising potential for application in Rh(D)-negative pregnant women.

Managing a Pregnancy in the Presence of the Rare Blood Group Antibody PP1Pk.

Pregnant women with p phenotype, who lack antigens P, P1, and Pk, spontaneously form anti-PP1Pk antibodies whose primary target is the placenta. The risk of miscarriage in these women is 50%-70% and reaches 87% in the second trimester. The therapies aim to reduce the titer of antibodies early in pregnancy. They also have risk of hemolytic transfusion reaction, with very few compatible red blood cell donors in the world. In this study, we present a case of successful pregnancy managed with autologous blood donations and plasmapheresis.

Efficacy of Preoperative Autologous Blood Donation for Surgical Treatment of Thoracic Spinal Stenosis: A Propensity-Matched Cohort Study.

OBJECTIVE: Thoracic spinal stenosis (TSS) surgeries necessitate a substantial amount of allogeneic blood resources. However, the efficacy of preoperative autologous blood donation (PABD) in TSS surgery has not been clearly evaluated. Therefore, we aimed to evaluate the efficacy of PABD for TSS surgery. METHODS: This study is a retrospective study. Totally 397 patients who underwent TSS surgeries at our institution from January 2019 to June 2023 were included. Propensity score matching (PSM) was used to make the PABD and Non-PABD groups comparable at baseline. Regarding outcome measures, the incidence and amount of allogeneic blood transfusion, changes in postoperative hemoglobin and hematocrit levels, occurrence of postoperative complications, medical costs, drainage time, length of hospital stay, and postoperative neurological function were analyzed. The outcomes were compared between the matched PABD (n = 79) and Non-PABD (n = 79) groups. Univariate analysis methods were used for statistical analysis, including independent samples t-test, Wilcoxon rank-sum test, and chi-square test. RESULTS: The incidence of allogeneic blood transfusion (8.9% vs. 25.3%, p = 0.006) and volume of intraoperative red blood cell (RBC) transfusion (10.12 ± 54.52 vs. 122.78 ± 275.00 mL, p < 0.001) in the PABD group were significantly lower than those in the Non-PABD group. The PABD group had significantly higher average postoperative hemoglobin and hematocrit levels than the Non-PABD group at 1, 3, and 5 days after surgery (p < 0.05). Similarly, the PABD group exhibited a smaller reduction in hemoglobin and hematocrit levels compared with the Non-PABD group on 1, 3, and 5 days postoperatively. There were no significant intergroup differences in terms of transfusion-related complications, medical expenses, neurological function, length of hospital stay, or drainage time. Notably, PABD was an independent protective factor of allogeneic transfusion in the multivariate regression analysis (OR = 0.334, 95%CI = 0.051-0.966). CONCLUSIONS: PABD can effectively reduce the incidence of allogeneic blood transfusion and amount of allogeneic blood in TSS surgeries with safety. It also significantly improved the postoperative hemoglobin and hematocrit levels. Under the premise of clear indications, PABD is worth promoting for the surgical treatment of TSS.

Comparison of whole blood collection and double-unit erythrocytapheresis in preoperative autologous blood donation.

INTRODUCTION: We compared preoperative autologous blood donation (PABD) using serial manual whole blood (WB) and PABD using a single session, double-unit erythrocytapheresis in terms of the hemodynamic recovery and clinical outcomes. MATERIALS AND METHODS: This study included 56 donors in the WB PABD group and 117 donors in the double-unit erythrocytapheresis PABD group. All subjects were men with body weight >70 kg, Hb level >13.3g/dL, Hct >40%, and who were scheduled for oral and maxillofacial surgery. Three cycles of manual WB collection for PABD or a single session, double-unit erythrocytapheresis using the Alyx was performed. RESULTS: There were no significant differences in donor demographic variables including age, height, weight, Hb, Hct, or red cell mass between the 2 groups. The double-unit erythrocytapheresis was completed earlier than the last manual WB PABD (at 15.3 ± 4.7 days and 6.5 ± 3.2 days before surgery, p<0.001). Hct values before surgery were higher in the double-unit erythrocytapheresis PABD group than in the manual WB PABD group (39.7 ± 3.2 vs. 38.6 ± 2.7, p=0.024). ΔHct and %ΔHct before the first PABD and before surgery were lower in the double-unit erythrocytapheresis PABD group than in the manual WB PABD group (-5.6 ± 2.8 vs. -6.8 ± 2.7, p=0.010 and -12.3 ± 5.9 vs. -14.8 ± 5.6, p=0.008, respectively). The incidence of additional allogeneic blood transfusions during or after surgery and the post-operative Hb and Hct values were similar in the 2 groups. The length of hospital stay after surgery was significantly longer in the manual WB PABD group than in the double-unit erythrocytapheresis group (6.1 ± 2.5 vs. 5.4 ± 1.9, p=0.043). Of the 33 donors in the double-unit erythrocytapheresis PABD group, 7 (21.2%) reported discomforts related to the procedure, and 6 graded the discomforts (hypocalcemia, perioral tingling sense, paresthesia, dizziness, stuffiness, pain on the intravenous site, and muscle tension) as mild. CONCLUSION: The single session, double-unit erythrocytapheresis prolonged the time interval between PABD and surgery and led to better hemodynamic recovery than the serial manual WB PABD, and hypocalcemic symptoms were mild.

The current status of autologous blood transfusion in Japan--the importance of pre-deposit autologous blood donation program and the needs to achieve patient blood management.

BACKGROUND: Autologous blood transfusion (ABT) is currently considered the safest transfusion, since the risks of allogeneic immunological reaction and viral transmission are theoretically null. Although its use has declined in Western countries in the recent decade, it has been progressively expanded in Japan. With the widening of the concept of patient blood management (PBM), which aims to prevent the harmful adverse effects of the exposure to allogeneic blood, the importance of the ABT has once again gained interest. STUDY DESIGN AND METHODS: Here, we retrospectively analyzed the cases pre-depositing autologous blood for an elective surgery in the period of January 2000 to December 2010 in our hospital, where a pre-deposit autologous blood donation (PAD) program has been established in 2006, in an attempt to analyze the improvements achieved, and the problems remaining to achieve patient blood management. RESULTS: The PAD program contributed for the further improvement of ABT, and the number of participating patients increased, especially in the period 2002-2003, when the idea of PAD program implementation came out. By simple extrapolation of the ABT data to allogeneic blood, ABT was found to be superior in terms of cost-effectiveness. However, problems such as the high wastage rate, and the inappropriate transfusion triggers remain to be solved. CONCLUSION: ABT plays the central role in PBM, but to achieve the real PBM, there is need to indicate ABT appropriately, according to the individual needs, and use it adequately, without discarding. Our present data reflect the present status of the ABT performance in Japan, and will serve as the basis for the development of strategies to achieve safe and appropriate performance of ABT, and consequently, achieve PBM.

Patient blood management in a neurosurgical patient with anti-e antibody.

The successful application of patient blood management approach in a 48-year-old neurosurgery patient planned for meningioma excision and requiring transfusion is described. The patient had multiple past immunizing events and developed antibody against a high-frequency antigen "e" of the Rh blood group system. With the joint effort from transfusion medicine specialist, anesthesiologist, and surgeon, the patient was successfully managed using the preoperative autologous blood donation program.

Tranexamic Acid Reduces Total Blood Loss and the Amount of Stored Preoperative Autologous Blood Donation Needed for Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion.

Introduction There are few published studies on posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) that have reported that the stored amounts of autologous blood donation (ABD) needed for the procedure were estimated by taking into account total blood loss (TBL). The aim of this study was to clarify the following clinical questions: (1) Does the use of tranexamic acid (TXA) reduce the TBL during PSF for AIS? (2) What volume of ABD should be stored to avoid allogeneic blood transfusions? Methods This study investigated 44 female patients who underwent PSF for AIS. A total of 33 patients underwent PSF without TXA (non-TXA group) and 11 patients underwent PSF with TXA (TXA group). TBL was determined by the hemoglobin (Hb) balance method calculated with circulating blood volume, Hb levels, hematocrit (Ht) levels before and three days after surgery, and the volumes of blood transfusions, including stored ABD. For the TXA patients, TBL was used to determine the appropriate amount of stored ABD and the number of ABD collections. Results The amount of TBL was lower in the TXA group compared to the non-TXA group. The mean required volume of stored ABD in the TXA group was 218.2 ± 577.3 mL, with a required maximum volume of 699.0 mL. The proportions of patients requiring allogeneic blood transfusion were as follows: 72.7% for those with no ABD collection, 45.5% for one ABD collection, and 0% for two ABD collections when TXA was used during surgery.  Conclusions TXA reduced the TBL of patients undergoing PSF for AIS. The maximum amount of stored ABD needed was 699.0 mL. Allogeneic blood transfusion can be avoided by storing two ABD collections when TXA is used during the surgery.

Overtransfusion of Autologous Blood Identifies Opportunities for Improving Patient Blood Management.

Background Preoperative autologous blood donation (PABD) has been declining in use nationally. A subset of patients scheduled for elective surgery, however, continue to be offered and choose this option. Our study aimed to understand the current impact of PABD before scheduled surgical procedures. Study design and methods A retrospective review was conducted in a single large academic center. Medical records associated with autologous units received in the transfusion service over a two-year period (1/1/2016-12/31/2017) were reviewed. Demographics, units donated, units transfused, wastage, pre-donation hemoglobin (Hb), pre-operative Hb, estimated blood loss (EBL), and clinical specialty were collected. Results During the study period, 118 patients underwent PABD, donating a total of 141 autologous red blood cell units. Patients who donated autologous units and were subsequently transfused had lower pre-donation Hb compared to patients who were not transfused (13.3 ± 1.4 g/dL vs. 14.3 ± 1.5 g/dL, p=0.004). Pre-operative Hb was lower than pre-donation Hb among both groups (12.1 ± 1.2 g/dL for patients receiving transfusion; 12.9 ± 1.5 g/dL, p=0.011 for patients who were not transfused). The majority of PABD patients (71%) had an estimated blood loss of less than 500 mL. Wastage rate of autologous units was 67%. PABD was disproportionately associated with a minority of surgeons and clinical services. Conclusion Within our institution, PABD is heavily used amongst a small subset of physicians across multiple surgical specialties and is associated with lower pre-operative Hb, tendency towards overtransfusion, and high rates of wastage of donated units. Our findings reinforce reports of inefficiencies in patient blood management and increased risks to patient health associated with PABD.

Application of Component Apheresis in Pre-deposited Autotransfusion.

OBJECTIVE: This study aims to evaluate the effects of preoperative autologous blood donation (PABD) using apheresis in patients who underwent elective surgical procedures, and investigate its clinical usefulness. METHODS: Data from 109 patients who underwent general and orthopedics elective surgery were analyzed in this study. Patients were divided into three groups: control group, patients who did not donate autologous blood; whole blood (WB) PABD group, patients who underwent preoperative autologous WB donation; autologous apheresis group, patients who donated autologous blood using erythrocytapheresis. Hb, Hct, and PLT levels in all patients were measured and compared before the operation and on postoperative days one and three. Furthermore, postoperative recovery indexes in the three groups were compared including allogeneic blood transfusions and postoperative hospitalization days. RESULTS: Hb, Hct, and PLT levels in the three groups after the operation were lower than levels before the operation. However, Hb levels were higher than 110 g/L and the Hct levels were not less than 33%. Differences in Hb and Hct drop values on postoperative days one and three among the three groups were statistically significant (P>0.05). Furthermore, PLT level in the control group was lower than in the WB PABD group and autologous apheresis group (P<0.05). PABD using erythrocytapheresis reduced blood transfusion (P<0.05). CONCLUSION: Erythrocytapheresis PABD led to an equal or even better postoperative recovery effect than WB PABD, and erythrocytapheresis PABD is feasible for blood transfusion therapy in patients undergoing elective surgical procedures.

A Study of Preoperative Autologous Blood Donation Timing.

This study aims to determine the safe and effective autologous blood drawing time for preoperative autologous blood donation (PABDs) by comparing the outcome of two different schedules of PABDs. A total of 144 patients who underwent elective surgery (radical resection of digestive tract tumor, lumbarspinesurgery and Intracranial tumor resection) were retrospectively reviewed. 88 patients had donated autologous blood 2 days before the operation (group 1); 56 patients had donated autologous blood more than 3 days before the operation (group 2). Hb and Hct before the operation and on postoperative days one and three, allogeneic blood transfusions, total bleeding, postoperative length of stay, and length of stay were measured and compared. Hb at postoperative day one was lower in group 2 than in group 1 (P < 0.05). Furthermore, Hb in group 1 was higher at postoperative day one than at postoperative day three (P < 0.05). Differences in postoperative Hct, allogeneic blood transfusions, total bleeding and postoperative length of stay between these two groups were not statistically significant (P > 0.05)., The difference in the average number of postoperative hospitalization days between these two groups was not statistically significant (P > 0.05). The 2 days of PABD did not lead to any adverse recovery effect. It would be helpful to conduct preoperative autologous blood transfusions.

A meta-analysis and systematic review evaluating the use of erythropoietin in total hip and knee arthroplasty.

PURPOSE: The debate is still ongoing on the effectiveness and safety of erythropoietin (EPO) treatment in orthopedic surgeries. Specifically, previous studies have not compared the dynamic change of hemoglobin (Hb) levels between different transfusion methods. Besides, complications or side effects of this alternative have not been quantitatively analyzed. We conducted a meta-analysis and systemic review to evaluate the efficacy of EPO on Hb levels observed during the whole perioperative period as well as the volume of allogeneic blood transfusion (ABT), the risk of venous thromboembolism, and application frequency of ABT in hip and knee surgery. MATERIALS AND METHODS: PubMed, Embase, Web of Science, and the Cochrane library were systematically searched from inception to November 2017. The data from randomized controlled trials were extracted and the risk of bias assessed using Cochrane's Collaboration's tool. RESULTS: Twenty-five randomized controlled trials involving 4,159 patients were included in this meta-analysis. EPO could reduce exposure to allogeneic blood transfused (odds ratio [OR] =0.42, P=0.001) and reduce the average volume of allogeneic blood transfused (OR = -0.28, P=0.002). When EPO and preoperative autologous blood donation (PABD) were compared, the use of EPO was associated with lower exposure to ABT (OR =0.48, P=0.03), but no significant decrease in the average volume of allogeneic blood transfused (OR = -0.23, P=0.32). The use of EPO was associated with a higher level of Hb with or without use of PABD at all the 4 time points (preoperation, 24-48 hours postoperation, 3-5 days postoperation, discharge of last observation) (P<0.0001), which means EPO could increase the level of Hb significantly during the perioperative period. The results also indicated EPO does not increase the risk of a venous thromboembolism event. CONCLUSION: Preoperative administration of EPO was shown to generally increase Hb levels during the whole perioperative period; however, the extent of the positive effects varies with time points. Additionally, EPO minimizes the need for transfusion significantly in patients undergoing hip or knee surgery without increasing the chance of developing thrombotic complications. Therefore, EPO offers an alternative blood management strategy in total hip arthroplasty and total knee arthroplasty.