Efficacy and cost effectiveness of autologous blood predeposit in patients undergoing radical prostatectomy procedures

Goodnough, Lawrence T.; Grishaber, Judy E.; Birkmeyer, John D.; Monk, Terri G.; Catàlona, William J.

doi:10.1016/s0090-4295(94)80136-3

Cited by 110 publications

(59 citation statements)

References 37 publications

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“…This is comparable to the 14% to 16% allogeneic blood exposure rates for patients who predonated three autologous blood units before radical prostatectomy 13,14 .…”

Section: Clinical Studiessupporting

confidence: 54%

“…dilution have been analyzed. The predonation of three autologous blood units had previously been shown to reduce allogeneic blood exposure to 14 to 16% in patients who underwent radical retropubic prostatectomy compared to 70% in patients without autologous blood 13,14 . A prospective trial 15 and a retrospective comparison of acute hemodilution to preoperative autologous blood donation 16 in patients undergoing radical prostatectomy showed that subsequent allogeneic blood exposure (10 to 20%) was not different for patients undergoing either method of autologous blood procurement.…”

Section: Clinical Studiesmentioning

confidence: 99%

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Acute Normovolemic Hemodilution

Goodnough

1999

Transfus Alt Transfus Med

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SUMMARY I Acute normovolemic hemodilution is a point of care method of autologous blood procurement. Acute hemodilution has several inherent advantages over preoperative autologous blood donation: it is inexpensive, does not require testing, and has none of the risks of administrative error or bacterial contamination related to stored blood. The clinical efficacy of acute hemodilution is increasingly apparent. This technique will also serve as a foundation for the use of emerging oxygen carrying solutions.

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“…This is comparable to the 14% to 16% allogeneic blood exposure rates for patients who predonated three autologous blood units before radical prostatectomy 13,14 .…”

Section: Clinical Studiessupporting

confidence: 54%

Section: Clinical Studiesmentioning

confidence: 99%

Acute Normovolemic Hemodilution

Goodnough

1999

Transfus Alt Transfus Med

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“…Accordingly, the percentage of autologous blood units transfused yearly in the US has increased from 0.8% in 1982, to 3.1% in 1989, and to 5.0% in 1992 [3, 4]. Preoperative autologous blood donation (PAD) had become standard practice in patients undergoing orthopedic procedures [5, 6]and radical prostatectomy [7, 8]. However, recent studies have reflected a decline in PAD since 1992; in 1997, the percentage of blood transfused in the US that was autologous was 3.7% [3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…However, recent studies have reflected a decline in PAD since 1992; in 1997, the percentage of blood transfused in the US that was autologous was 3.7% [3, 4]. Recent reports have demonstrated that this practice is not cost–effective and of is uncertain benefit [7, 9, 10, 11]. As an alternative, acute normovolemic hemodilution (ANH) represent ‘point of care’ autologous blood procurement which is much less costly than PAD [12].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of Acute Normovolemic Hemodilution Compared to Preoperative Autologous Blood Donation in Total Knee Arthroplasty

et al. 1999

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The value of acute normovolemic hemodilution (ANH) compared to preoperative autologous blood donation (PAD) in elective surgery is controversial. We therefore conducted a prospective, randomized study to compare these techniques in patients undergoing total knee arthroplasty. ANH patients underwent up to 4 units phlebotomy or to a target hematocrit level of 28% after induction of anesthesia. PAD patients were asked to donate 1 (unilateral) or 2 (bilateral, revisions) units before admission. Mean baseline hematocrit levels were not different between ANH and PAD patients (40.6±4.1 vs. 38.4±3.4, p = 0.09). Eight (73%) of 11 patients undergoing bilateral revision procedures received a total of 22 allogeneic blood units, whereas only 3 (14%) of 21 patients undergoing primary, unilateral procedures received a total of 3 allogeneic units (p = 0.002). We found no differences in allogeneic blood transfusions between ANH and PAD cohorts for all (n = 32) patients (1.0±1.2 vs. 0.6±1.4, p = 0.45), for unilateral knee (n = 21) replacement (0.25±0.46 vs. 0.08±0.28, p = 0.29), or for bilateral/revision (n = 11) procedures (1.9±1.3 vs. 2.5±1.9, p = 0.53). We conclude that each technique is equally effective in reducing allogeneic blood exposure. Patients undergoing revision or bilateral knee arthroplasties require adjunctive therapy to autologous blood procurement to further reduce allogeneic blood exposure.

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“…This analysis, however, did not properly model for all the direct and indirect health-effects of RBC transfusion and its avoidance. 23 For example, a review of the economic analyses of PAD shows that the cost-effectiveness estimates for PAD are also clearly unfavourable when these healtheffects are not included in the analysis, [24][25][26] but once they are included, the estimates become favourable. [27][28][29] In addition, PET, by increasing Hb concentration throughout the hospital stay, may improve functional recovery as has been demonstrated in patients undergoing surgery for hip fracture.…”

Section: Discussionmentioning

confidence: 99%