To determine the extent to which autologous blood that has been donated in advance ("predeposited") is used in patients undergoing elective surgery and to assess whether predonation decreases the use of homologous blood and the demand on the blood supply, we studied 4996 patients undergoing elective surgery at 18 tertiary care hospitals. Cross-matched blood was ordered for 1287 patients (26 percent), and of these, 590 (46 percent) were considered eligible for predepositing blood. Only 5 percent (32) of the eligible patients actually predeposited blood, indicating that predonation is not widely used. Of those who predeposited, only 13 percent (4 of 32) subsequently received homologous blood, as compared with 36 percent (199 of 558) of those who did not predeposit (P less than 0.01). Among the 199 patients who did not predeposit but required transfusion, we estimate that predonation could have avoided homologous transfusion in as many as 68 percent. If all eligible patients had predeposited autologous blood, they could have supplied as much as 72 percent of their own transfused red cells. The blood for as much as 10 percent of all red-cell transfusions could have been predonated by and transfused into the patients undergoing elective surgery. Greater use of predonation would not only reduce the demand on the blood supply by decreasing the need for homologous transfusion, but would probably also reduce the risk of hepatitis and other transfusion-associated illnesses.
Fresh frozen plasma (FFP) normally requires about 45 min to thaw in a 37 degrees C water bath when placed inside an additional plastic overbag. That relatively prolonged time may result in non-utilization or delays in delivery of the product, especially, during emergency surgery. One report recommends the use of a microwave oven to overcome those problems. Most blood banks do not have microwave ovens but usually do have water baths at 56 degrees C. Ten units of FFP thawed inside plastic overbags at 37 degrees C required 49.5 +/- 3.9 min and 22 units thawed at 56 degrees C required 28.3 +/- 4 min to thaw. Removal of the plastic overbag reduces the thawing time to 12-13 min at 56 degrees C. The activity Factor V was 85 +/- 15% (65-106%) at 37 degrees C and 80 +/- 21% (47-118%) at 56 degrees C. Factor VIII activity was 86 +/- 21% (59-118%) at 37 degrees C and 90 +/- 37% (46-225%) at 56 degrees C. There were no demonstrable alterations in fibrinogen, PT, APTT, Factor II, VII, IX, and XI between the two thawing temperatures, even after 24 hours of storage at 4 degrees C.
Sera from 12 multitransfused patients who were refractory to random-donor platelets were tested for lymphocytotoxic and leukoagglutinating antibodies using panel cells from various volunteers whose HLA-A and -B antigens were known. All sera contained leukoagglutinins reactive with cells from at least one panel member, whereas only 33% had lymphocytotoxic antibodies. Patients whose sera reacted frequently with panel cells using the microcapillary agglutination technic seldom responded to HLA-matched paltelets, whereas those whose sera reacted infrequently usually responded satisfactorily. It is concluded that non-HLA antibodies may play a significant role in determining the responses to platelet transfusions in multi-transfused patients.
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