Predonated autologous blood use in elective cardiac surgery

Britton, Lewis W.; Eastlund, D. Ted; Dziuban, Stanley W.; Foster, Eric D.; McIlduff, Joseph B.; Canavan, Thomas E.; Older, T M

doi:10.1016/0003-4975(89)90427-x

Cited by 88 publications

(18 citation statements)

References 22 publications

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“…Six studies 8,13,14,20,22,25 provided data that enabled an accurate assessment of the number of autologous units not used. With the exception of the study that transfused all predonated units regardless of the patients' hemoglobin †Day 7 or the value closest to day 7.…”

Section: Unused Autologous Bloodmentioning

confidence: 99%

“…The 6 randomized studies [16][17][18][19][20] were conducted in patients who underwent the following types of procedures: colorectal surgery for bowel cancer (3), hip arthroplasty (2), and liver resection (1). All 6 studies demonstrated a statistically significant decrease in exposure to allogeneic blood in patients who predeposited autologous blood compared with those who did not.…”

Section: Efficacy In Randomized Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion<subtitle>Results of a Meta-analysis</subtitle>

Forgie¹

1998

Arch Intern Med

241

112

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Preoperative autologous donation of blood decreases exposure to allogeneic blood but increases exposure to any transfusion (allogeneic and/or autologous). There is a direct relationship between the transfusion rate in the control group and the benefit derived from preoperative autologous donation. This suggests that other methods of decreasing blood transfusion, such as surgical technique and transfusion protocols, may be as important as preoperative autologous donation of blood.

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Section: Unused Autologous Bloodmentioning

confidence: 99%

Section: Efficacy In Randomized Studiesmentioning

confidence: 99%

Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion<subtitle>Results of a Meta-analysis</subtitle>

Forgie¹

1998

Arch Intern Med

241

112

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“…There is considerable experience with Jehovah's witnesses who receive no blood during cardiac surgery and tolerate hemoglobin levels as low as 50 gm/L without suffering increased morbidity [19]. The safe limits for normovolemic anemia in cardiac patients have not been defined, but there is a suggestion that this may be poorly tolerated prior to anesthesia and surgery in patients with coronary artery disease [20].…”

Section: Discussionmentioning

confidence: 99%

Limiting the Usage of Blood Products in Cardiovascular Surgery

1991

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We studied the effect of the initiation of a five part program of blood component conservation on blood product utilization in patients undergoing major cardiovascular surgery. We encouraged physicians and nurses to adhere to a set of guidelines that would limit the exposure of these patients to complications associated with blood product administration. Through this effort the amounts of packed red cells, fresh frozen plasma, platelets, and cryoprecipitate used were markedly reduced. After the start of the conservation program, overall blood product usage was reduced 29% despite a 46% increase in the surgical caseload, and there was a 53% decrease in the amount of donor exposure (units of individual blood products administered) per patient. Surgery. 1991; 11(2): 213-217 Modern transfusion practice in cardiac surgery is directed toward keeping the number of administered blood bank products to a minimum. In some hospitals, over 90% of patients undergoing coronary artery bypass grafting (CABG) do not receive any blood products as part of a comprehensive blood conservation program [1]. We recently reevaluated our use of blood products and embarked on a program to reduce the amount of patient exposure to infectious agents such as HIV-1 and hepatitis viruses. This effort was based on the following maneuvers whenever possible: removal of 450 to 900 ml of the patient's blood prior to cardiopulmonary bypass with reinfusion after reversal of heparinization; reinfusion of all possible blood from the oxygenator at the conclusion of bypass; withholding the prophylactic administration of fresh frozen plasma (FFP), platelets, and cryoprecipitate until laboratory tests indicated specific coagulation deficits; acceptance of postoperative normovolemic anemia (hematocrit, 25-30%); and reinfusion of postoperative mediastinal drainage. We report here the results of a concerted effort in the operating room and ICU to use less blood products in patients undergoing a variety of cardiac surgical operations. PE Horowitz, CM Lorenzen, RD Rhydderch, Limiting the Usage of Blood Products in Cardiovascular MethodsWe studied the blood product utilization of all patients at our hospital who were undergoing CABG, single valve replacement or repair, multiple valve operations, reoperations for valve repair or replacement, closure of atrial septal defect in patients above and below 16 years of age, and ventriculoseptal defect closure. All patients undergoing these operations from February 1 to August 31, 1988, were placed in the control group (Group I). A second group of patients operated on from May 1 to October 31, 1989 (Group II), was studied after the introduction of a new set of procedures and guidelines governing blood product administration. Limiting The Usage of Blood Products in Cardiovascular SurgeryAnnals of Saudi Medicine, Vol 11 No. 2; 1991 The following conservation techniques were utilized whenever possible for the patients in Group II: 1. Withdrawal of 450 to 900 ml of the patient's blood from the sideport of an 8.5 F percut...

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“…However, the population studied by Popovsky et al [17]may not be representative of autologous blood donors with cardiovascular disease, and hospitalization may not be an appropriate marker of serious complications for this patient population. We believe that in autologous blood donors with cardiovascular disease there is a much higher incidence of adverse reactions (e.g., increasing angina, with an incidence as high as 12% in autologous blood donors with coronary artery disease [18]) which may not necessarily lead to hospitalization but, nevertheless, must be considered as serious. Although it is difficult to determine whether such reactions are causally related to blood donation or simply symptoms of underlying disease, they may be provoked or worsened by hypotension and hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

Lactated Ringer’s Solution versus Hydroxyethyl Starch for Volume Replacement in Autologous Blood Donors with Cardiovascular Disease:& ;A Controlled, Randomized Trial

et al. 1998

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Background and Objectives: The study was designed to evaluate whether volume replacement following blood donation can prevent arterial hypotension in autologous blood donors with cardiovascular disease. Materials and Methods: One hundred nineteen autologous blood donors with known cardiovascular disease were randomly allocated to receive, following withdrawal of 500 ml of blood, either no infusion (control group) or a 25 ml/min intravenous infusion of either 1,500 ml of lactated Ringer’s solution (LRS) or 500 ml of 6% hydroxyethyl starch (HES). Starting before phlebotomy, arterial blood pressure was measured oscillometrically every 5 min until 90 min after donation. Results: Group means showed little difference between the groups in blood pressure throughout the monitoring period. The proportion of patients who at least once had a ≥ 20% decrease from baseline in systolic blood pressure was 3–5 times greater in the control group than in the LRS and the HES group (50 vs. 10 and 15%, respectively; p < 0.001 on χ² analysis for a 2 × 3 table). Systolic hypertensive episodes (≥ 20% increase over baseline) were observed more frequently in the LRS group than in the control and the HES group (41 vs. 10 and 18%, respectively; p = 0.003). Conclusion: Both LRS and HES, administered at a volume ratio to blood loss of 3:1 and 1:1, respectively, significantly reduced the incidence of systolic hypotensive episodes in autologous blood donors with cardiovascular disease. LRS at a 3:1 volume ratio to blood loss was associated with a high rate of systolic hypertension.

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Predonated autologous blood use in elective cardiac surgery

Cited by 88 publications

References 22 publications

Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion<subtitle>Results of a Meta-analysis</subtitle>

Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion<subtitle>Results of a Meta-analysis</subtitle>

Limiting the Usage of Blood Products in Cardiovascular Surgery

Lactated Ringer’s Solution versus Hydroxyethyl Starch for Volume Replacement in Autologous Blood Donors with Cardiovascular Disease:& ;A Controlled, Randomized Trial

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Predonated autologous blood use in elective cardiac surgery

Cited by 88 publications

References 22 publications

Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion<subtitle>Results of a Meta-analysis</subtitle>

Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion<subtitle>Results of a Meta-analysis</subtitle>

Limiting the Usage of Blood Products in Cardiovascular Surgery

Lactated Ringer&rsquo;s Solution versus Hydroxyethyl Starch for Volume Replacement in Autologous Blood Donors with Cardiovascular Disease:& ;A Controlled, Randomized Trial

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Lactated Ringer’s Solution versus Hydroxyethyl Starch for Volume Replacement in Autologous Blood Donors with Cardiovascular Disease:& ;A Controlled, Randomized Trial