[The importance of autologous blood transfusion in the Federal Republic of Germany. Results of a survey carried out in 1989].

The study was designed to evaluate the role of autologous blood transfusion in current clinical practice. METHODS. Standardized questionnaires were distributed to the anesthesia departments of 421 randomly selected hospitals in the 'old' Federal Republic of Germany and West Berlin in August 1989. The questionnaires contained 26 questions relating to (1) the particular hospital, (2) preoperative autologous blood donation (PABD), (3) preoperative plasmapheresis, (4) isovolemic hemodilution, (5) intra- and postoperative autotransfusion, (6) general practice followed in blood transfusion, and (7) blood salvage in children. RESULTS. In all, 207 completed questionnaires (49%) were returned, 12% of which came from university hospitals, 25% from hospitals with more than 500 beds, 58% from hospitals with fewer than 500 beds and 5% from smaller specialized hospitals. Over half (52%) of the responding hospitals were running their own transfusion services or were located in the vicinity of a regional blood bank. The overall proportion of surgical procedures requiring perioperative blood transfusions was 10%. PABD was performed "not at all" in 24% of the hospitals, "rarely" in 28%, "occasionally" in 24%, "frequently" in 10%, and "routinely" in 13%. PABD was standard in 75% of the departments of orthopedic surgery, in 68% of the departments of cardiac surgery, and in 33% of the departments of vascular surgery. In two-thirds of the hospitals reporting the use of PABD, the anesthesia departments were in charge of the autologous blood service. For 64% of the hospitals, liquid storage of whole blood was reported as the standard technique. Patients normally not eligible for homologous blood donation according to established donor criteria were accepted for autologous blood donation at most "occasionally" in 60% of the hospitals, but "frequently" or "mostly" in 36%. Preoperative autologous plasmapheresis was performed when major intraoperative blood loss was anticipated in 12% of the hospitals. Isovolemic hemodilution was performed "not at all" in 30% of the hospitals, "rarely" in 17%, "occasionally" in 25%, "frequently" in 14%, and "mostly" in 12%. The reasons most frequently given for not performing hemodilution were "too time-consuming" (41%) and "too little blood-saving effect" (32%). Autotransfusion devices were available in 40% of the hospitals. Others deemed such devices "badly needed" (5%) or "desirable" (43%), while 45% found them "not necessary." The principal use of intraoperative autotransfusion was in cardiac surgery (79% of the departments), orthopedics (47% of the departments) and vascular surgery (45% of the departments). In 29% of the responding hospitals autotransfusion devices were also used for postoperative autotransfusion ("seldom" in 7%, "occasionally" in 10%, "frequently" in 6%, "mostly" in 6%). In the absence of cardiopulmonary disease, hemoglobin concentrations below 8-10 g/dl were considered an indication for blood transfusion. In patients with compromised cardiopulmonary function the lowest acceptable level was 10-12 g/dl. Blood salvage techniques are obviously rarely used in children. Experiences with PABD in children were reported by 14.5% of the hospitals, experience with isovolemic hemodilution by 22% and with intra- and postoperative autotransfusion in 18% and 12.5% of the hospitals, respectively. Preoperative plasmapheresis was performed in children in 3.5% of the hospitals. CONCLUSIONS. Although the present sample is not representative on a national level, our findings allow the conclusion that the simple techniques of both preoperative autologous blood donation and isovolemic hemodilution are unduly neglected in surgical and anesthetic practice, whereas even smaller hospitals are fairly well equipped with sophisticated autotransfusion devices.