Predonated autologous blood transfusion in elective orthopaedic surgery:A hospital experience

Apollo Medicine 2012 DecemberVolume 9, Number 4; pp. 351e352 Journal Scan

Predonated autologous blood transfusion in elective orthopaedicsurgery: A hospital experience

R.N. Makroo*

Predonated autologous blood transfusion in elective orthopaedic surgery: a hospital experience. Essoh S, Soro L,Krah L, Abo Y, Lambin Y.Niger J Orthop Trauma. 2007;6(2):52e54.

Abstract:Background: The use of homologous blood carries significant risk of viral infections and immune-mediated reactions.Preoperative autologous blood donation is an attractive alternative to homologous transfusion and has become commonin elective orthopaedic surgery.Objective: To present our experience with the use of preoperative autologous blood donation program in elective ortho-paedic surgery.Design/setting: A prospective study of patient charts and blood bank records carried out between March 1998 and August1999 at the Department of Orthopaedic Surgery, Yopougon Teaching Hospital, Abidjan, Côte d\’Ivoire.Patients and methods: Twenty patients scheduled for elective orthopaedic procedures entered the program. There were 13men and seven women with a mean age of 33.1 years. Fifteen of them were operated on and transfused.Main outcome measures: The number of units of blood collected, autologous or homologous transfusion requirements, sideeffects encountered during donation and transfusion of blood were documented.Results: Of the 62 units requested 57 (91.9%) were collected. We were able to meet 86.7% of transfusion requirements withautologous blood. The incidence of homologous transfusion was 13.3%. Thirty-eight (66.7%) units were transfused. The rateof wastage of units was 33.3%. There were no major complications as a result of the patients either giving their own blood orreceiving any blood products.Conclusions: This study confirms that autologous blood transfusion is an effective way of reducing the need for homologousblood. The procedure of preoperative autologous blood donation is cost effective, safe, and should be widespread.

COMMENTS

An increased demand on available blood supply is created by an increase in the number of surgical procedures owing toadvances in medical care. Even after employing stringent donor selection criteria and advanced testing techniques for detectionof various transfusion transmissible infections, any transfusion service, across the globe cannot assure “Zero risk blood”. Thiscoupled with the increasing awareness and the somewhat unjustified fear of contracting HIV/AIDS among the common peoplehave further complicated the matter. Both, the surgeons as well as patients are becoming more and more conscious of the risksassociated with allogeneic blood transfusion like transmission of transfusion transmissible infections as well as transfusionreactions.An autologous blood transfusion program is one method of accomplishing the goal of minimizing allogeneic bloodusage. Orthopaedic surgeries especially joint replacement surgeries are mostly elective in nature, with the patients having ampletime preoperatively for planning procedures like autologous blood donations.

Director & Senior Consultant, Department of Transfusion Medicine, Molecular Biology & Transplant Immunology, New Delhi, India.*Tel.: þ91 9810170969, email: makroo@apollohospitals.com

Received: 20.8.2012; Accepted: 21.8.2012; Available online 27.8.2012http://dx.doi.org/10.1016/j.apme.2012.08.008

352 Apollo Medicine 2012 December; Vol. 9, No. 4 Makroo

The authors have effectively demonstrated the success of preoperative autologous blood collection followed by intraoper-ative transfusion in reducing the requirements for homologous blood. With both men and women participating in the study, thesurgeons could meet 86.7% of the intraoperative blood requirements by the preoperatively collected autologous blood alone.They strongly recommend the use of autologous transfusion, as a cost effective and safe alternative to the use of homologousblood.

In our experience we have performed preoperative autologous blood collection in only one male patient undergoing kneereplacement. The patient had no complications while donation or transfusion of the unit. As per the recommended guidelinesthere are no age limits for autologous blood donation, and the haemoglobin concentration of the donor patient should be no lessthan 11 g/dl. Besides this there are other eligibility criteria concerning the health of the donor patient and his/her possiblecompliance with repeated blood collections. Several patients, especially elderly men/women who undergo joint replacements(which are by far the most frequent elective orthopaedic surgeries at our hospital) may not fulfil the eligibility criteria.Although, we agree with the authors regarding the safety and cost effectiveness of the technique, however, the feasibility ofthe same in our setting still needs to be evaluated.