Autologous blood donation (ABD) reduces both the real and perceived risks of allogeneic blood exposure, although wasted units increase overall costs. Wastage of autologous blood can be contained by using rational blood ordering and collection strategies. These identify procedures with transfusion requirements, utilizing ABD predeposit in patients undergoing surgery for which the need for blood transfusion has been clearly established, and where the average blood loss for each procedure has been determined. ABD programmes can be optimized by adopting a personalized approach for each individual patient. The predicted and tolerated blood loss is calculated for each patient, and the difference between the two determines the patient's transfusion need. Taking into account the type of surgery, time to surgery and the clinical condition of the patient, the best and most cost-conscious transfusion strategy can then be determined. Options include: reducing the blood loss pharmacologically, transfusing allogeneic blood, using autologous blood from a variety of techniques, using recombinant erythropoietin (epoetin alfa) to increment baseline haematocrit (Hct) or to increase the volume of predonated blood, and using blood substitutes in addition to autotransfusion techniques. Autotransfusion techniques available include ABD predeposit, normovolaemic haemodilution and perioperative salvage. ABD predeposit may be limited by the delay in the natural erythropoietic response to allow recovery of red cells collected. Together with adequate iron support, epoetin alfa accelerates recovery of the Hct and increases the tolerated blood loss. The availability and judicious use of these blood conservation strategies provide for both effective and cost-conscious blood transfusion strategies.

For patients who donate blood for autologous use and undergo major orthopedic surgery, low basal hematocrit (Hct) is the major cause of allogeneic blood exposure. To determine whether recombinant human erythropoietin (rHuEPO) could increase autologous blood procurement and reduce allogeneic blood exposure, a prospective randomized study was conducted in 50 women undergoing total hip replacement who had basal Hct < 40 percent (0.40). Patients were randomly placed in three groups: those receiving placebo, those receiving 300 U of rHuEPO per kg, and those receiving 600 U of rHuEPO per kg every 3 to 4 days for 21 days. Oral iron (125-270 mg/day) was given; in the last 24 patients, 100 mg of iron saccharate was administered intravenously at each donation. At each visit, 350 mL of blood was collected if Hct was > or = 34 percent (0.34). Patients receiving rHuEPO donated a greater amount of blood for autologous use than did patients in the placebo group (4.5 +/- 1.1 vs. 2.8 +/- 0.6 units; p < 0.05) and received a significantly lower amount of allogeneic blood (1.2 +/- 1.4 vs. 0.4 +/- 0.8 units; p < 0.05). No difference between the effects of the two doses of rHuEPO was observed. Iron support was a critical factor in the efficacy of treatment. No untoward effects were observed. The rHuEPO emerged as a safe and effective treatment, with adequate iron support, by which to increase preoperative deposit of autologous blood and to reduce exposure to allogeneic blood for patients with low basal Hct.

Recombinant human erythropoietin is safe and effective in stimulating erythropoiesis, allowing preoperative donation of blood for autologous use, and reducing exposure to allogeneic blood for RA patients who are unable preoperatively to deposit blood because of anemia.

Clerical errors occurring during specimen collection, issue and transfusion of blood are the most common cause of ABO incompatible transfusions. 40-50% of the transfusion fatalities result from errors in properly identifying the patient or the blood components. The frequency and type of errors observed, despite the implementation of measures to prevent them, suggests that errors are inevitable unless major changes in procedures are adopted. A fail-safe system, which physically prevents the possibility of error, was adopted in January 1993 and concurrently a quality improvement program was implemented to monitor any transfusion errors. Up to December 1994, 10,995 blood units (5,057 autologous and 5,938 allogeneic) were transfused to 3,231 patients. Seventy-one methodological errors (1/155 units) were observed, half of which were concentrated during the first 4 months of introducing the system. However the system detected and avoided four potentially fatal errors (1/2,748 units). Two cases involved the interchanging of recipient sample tubes, 1 case was due to patient misidentification and the other involved misidentification of blood units. In conclusion the system is effective in detecting otherwise undiscovered errors in transfusion practice and can prevent potential transfusion-associated fatalities caused by misidentification of blood units or recipients.

Clerical errors occurring during specimen collection, issue and transfusion of blood are the most common cause of AB0 incompatible transfusions. 40-50% of the transfusion fatalities result from errors in properly identifying the patient or the blood components. The frequency and type of errors observed, despite the implementation of measures to prevent them, suggests that errors are inevitable unless major changes in procedures are adopted. A fail-safe system, which physically prevents the possibility of error, was adopted in January 1993 and concurrently a quality improvement program was implemented to monitor any transfusion errors. Up to December 1994, 10,995 blood units (5,057 autologous and 5,938 allogeneic) were transfused to 3,231 patients. Seventy-one methodological errors(1/155 units) were observed, half of which were concentrated during the first 4 months of introducing the system. However the system detected and avoided four potentially fatal errors (1/2,748 units). Two cases involved the interchanging of recipient sample tubes, 1 case was due to patient misidentification and the other involved misidentification of blood units. In conclusion the system is effective in detecting otherwise undiscovered errors in transfusion practice and can prevent potential transfusion-associated fatalities caused by misidentification of blood units or recipients.

We investigated the safety and efficacy of preoperative epoetin alfa used in conjunction with preoperative autologous blood donation (PAD) in 40 anemic orthopedic surgical patients undergoing hip replacement surgery [hematocrit (Hct) ≤39%]. Patients were randomized 25–35 days before surgery to twice weekly intravenous (i.v.) epoetin alfa (300, 150, or 75 IU/kg) or placebo treatments supplemented with 200 mg i.v. iron. Epoetin alfa facilitated dose-dependent increases in PAD (4.3 units, 300 IU/kg; 3.4 units, 150 IU/kg; 3.0 units, 75 IU/kg; 2.1 units, placebo), and minimized reductions in Hct associated with repeated phlebotomy. All epoetin alfa doses were well tolerated and safe. Our results indicate that preoperative epoetin alfa dose-dependently stimulates erythropoiesis and facilitates PAD in anemic orthopedic patients, which may benefit patients by reducing their exposure to the risks of allogeneic transfusion, hastening recovery and discharge from hospital.

Lower dose of Epoetin alfa (reduced by 56%), supplemented by i.v. iron, is as effective and well tolerated as higher doses administered i.v., supplemented by i.v. iron.

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