Graham I D, Fergusson D, Dokainish H, Biggs J, McAuley L, Laupacis A
Clinical Epidemiology Unit, Loeb Health Research Institute, Ottawa Hospital, Ont.
CMAJ. 1999 Apr 6;160(7):989-95.
Preoperative autologous donation is one way to decrease a patient's exposure to allogeneic blood transfusion. This study was designed to determine patients' perceptions about the autologous blood donation process and their experiences with transfusion.
To assess patient perception, a questionnaire was administered a few days before surgery to patients undergoing elective cardiac and orthopedic surgery in a Canadian teaching hospital. All patients attending the preoperative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient charts were reviewed retrospectively to assess actual transfusion practice in all cases.
A total of 80 patients underwent cardiac surgery (40 autologous donors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous donors, 35 nondonors). Of the autologous donors, 75 (96%) attended all scheduled donation appointments, 73 (93%) said that they were "very likely" or "likely" to predonate again, and 75 (96%) said that they would recommend autologous donation to others. There was little difference in preoperative symptoms between the autologous donors and the nondonors, although the former were more likely than the latter to report that their overall health had remained the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surgery patients). When the autologous donors were asked what they felt their chances would have been of receiving at least one allogeneic blood transfusion had they not predonated, the median response was 80%. When they were asked what their chances were after predonating their own blood, the median response was 0%. The autologous donors were significantly less likely to receive allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] for orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allogeneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for orthopedic surgery).
Patients who underwent preoperative autologous blood donation were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated and underestimated their chances after they had predonated. They were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate.
术前自体献血是减少患者异体输血暴露的一种方法。本研究旨在确定患者对自体献血过程的看法以及他们的输血经历。
为评估患者的看法，在手术前几天对加拿大一家教学医院接受择期心脏和骨科手术的患者进行问卷调查。在10个月期间到术前自体献血诊所就诊的所有患者均符合条件。从未预先献血的相同类型手术患者中选取便利样本。回顾性查阅患者病历以评估所有病例的实际输血情况。
共有80例患者接受心脏手术（40例自体献血者，40例非献血者），73例接受骨科手术（38例自体献血者，35例非献血者）。在自体献血者中，75例（96%）参加了所有预定的献血预约，73例（93%）表示他们“非常可能”或“可能”再次预先献血，75例（96%）表示他们会向他人推荐自体献血。自体献血者和非献血者术前症状差异不大，尽管前者比后者更有可能报告在手术前一个月内他们的整体健康状况保持不变（心脏手术患者中分别为30例[75%]对21例[52%]，骨科手术患者中分别为30例[79%]对18例[51%]）。当自体献血者被问及如果他们没有预先献血，他们认为自己接受至少一次异体输血的可能性有多大时，中位数回答是80%。当被问及预先献了自己的血后可能性有多大时，中位数回答是0%。与非献血者相比，自体献血者接受异体输血的可能性显著更低（心脏手术中为6例[15%]，骨科手术中为3例[8%]）（心脏手术中非献血者为14例[35%]，骨科手术中为16例[46%]）。然而,与非献血者相比，他们接受任何输血（自体或异体）的可能性更大（心脏手术中分别为25例[63%]对14例[35%]，骨科手术中为31例[81%]对16例[46%]）。
接受术前自体献血的患者对该经历持积极态度，且未报告比术前未献血的患者更多的症状。自体献血者高估了如果不预先献血他们接受异体输血的可能性，而低估了预先献血后的可能性。与未预先献血的患者相比，他们接受异体输血的可能性较小，但接受任何类型输血的可能性较大。
