Ranchère J Y, Bruneau B, Gordiani P, Clapisson G, Tranchand B, Philip I
Département d'Anesthésie-Réanimation, Centre Régional de Lutte contre le Cancer Léon-Bérard, Lyon.
Ann Fr Anesth Reanim. 1990;9(6):480-4. doi: 10.1016/s0750-7658(05)80219-9.
In order to avoid the infectious and immunological complications of homologous blood given to autologous bone marrow graft recipients, intraoperative haemodilution together with delayed salvage of the red blood cells contaminating the marrow graft were used prospectively over a period of 6 months. This was carried out in 74 patients, i.e. 2 allogenic and 72 autologous donors (mean age 27.2 +/- 19.7 years). A mean of 13.66 +/- 7.10 ml.kg-1 bone marrow were harvested. Fluid replacement was carried out, volume for volume, with a modified fluid gelatin (Plasmion) (n = 73; 14.6 +/- 6.6 ml.kg-1), glucose 5% (n = 54; 9.64 +/- 4.88 ml.kg-1) and Ringer solution (n = 33; 8.1 +/- 3.3 ml.kg-1). No haemodynamic problems occurred. Autologous blood transfusion was possible in 54 patients; mean volume of bone marrow harvested was 631 +/- 298 ml, and a mean of 293 +/- 154 ml of blood was retransfused to the patients (mean haematocrit of the blood units: 0.536 +/- 0.048). Nine of these patients were also given homologous blood. In the other 20, the volume of bone harvested marrow was significantly lower than in the autologous transfusion group (430 +/- 202 ml; p less than 0.05), and red blood cell salvage was not possible; only 3 patients received homologous blood. Finally only 16.2% of the patients in this series were given homologous blood. It is concluded that intentional isovolaemic haemodilution together with autotransfusion of salvaged blood can reduce the need for homologous blood during bone marrow harvesting.
为避免给自体骨髓移植受者输注同源血所带来的感染及免疫并发症，在6个月的时间里前瞻性地采用了术中血液稀释及延迟回收污染骨髓移植物中的红细胞的方法。该方法应用于74例患者，即2例同种异体供者和72例自体供者（平均年龄27.2±19.7岁）。平均采集骨髓13.66±7.10ml·kg⁻¹。采用改良液体明胶（血浆代用品）（n = 73；14.6±6.6ml·kg⁻¹）、5%葡萄糖（n = 54；9.64±4.88ml·kg⁻¹）和林格液（n = 33；8.1±3.3ml·kg⁻¹）进行等量液体补充。未出现血流动力学问题。54例患者可行自体输血；平均采集骨髓量为631±298ml，平均回输给患者293±154ml血液（回输血液单位的平均血细胞比容：0.536±0.048）。其中9例患者还输注了同源血。另外20例患者采集的骨髓量明显低于自体输血组（430±202ml；p＜0.05），无法回收红细胞；仅3例患者接受了同源血。该系列患者中最终仅有16.2%的患者输注了同源血。结论是，有意等容血液稀释联合回收血自体输血可减少骨髓采集期间对同源血的需求。
