Sakai Ayumi, Matsunaga Shigetaka, Nakamura Eishin, Samejima Kouki, Ono Yoshihisa, Yamamoto Koji, Takai Yasushi, Maeda Hiroo, Seki Hiroyuki
Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
Department of Transfusion Medicine and Cell Therapy, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
J Obstet Gynaecol Res. 2019 Sep;45(9):1843-1850. doi: 10.1111/jog.14044. Epub 2019 Jun 25.
The high rate of stored preoperative autologous blood wastage is concerning. This study analyzed patients who provided preoperative autologous blood donations (PABDs) for massive bleeding during surgery for placenta previas and low-lying placentas, and investigated the optimal PABD storage volume required to avoid allogeneic transfusion.
Of 386 patients who provided PABDs at our hospital from 2008 to 2013, 269 patients with placenta previas or low-lying placentas were retrospectively analyzed. The PABD storage volumes were stratified into four groups based on the amounts stored, and the allogeneic transfusion usage frequencies were compared.
A total of 124 patients (46.1%) received PABDs and 12 patients (4.5%) received allogeneic transfusions. The average PABD volume wasted was 23 940 mL/year. The allogeneic transfusion utilization rate was significantly higher in the 1- to 300-mL group (17.2%) than in the 301- to 600-mL (1.69%), 601- to 900-mL (3.82%), and 901- to 1200-mL (0%) groups (P < 0.05). The PABD cut-off volume for avoiding allogeneic blood transfusion was 300 mL, and the odds ratio for ≤300-mL PABD in a multivariate analysis was 14.3 (95% confidence interval 1.3-149.3; P = 0.03). The maximum surgical blood order schedule was 2.16 units (432 mL), and the surgical blood order equation was 2.15 units (430 mL).
The allogeneic transfusion utilization rate did not differ between the 600-mL group and the groups with higher PABD storage volumes; hence, storing 600 mL of PABD was appropriate for surgery for placenta previas and low-lying placentas.
术前自体血储存损耗率较高令人担忧。本研究分析了为前置胎盘和低置胎盘手术中大量出血提供术前自体血捐献（PABD）的患者，并探讨避免异体输血所需的最佳PABD储存量。
回顾性分析2008年至2013年在我院进行PABD的386例患者中的269例前置胎盘或低置胎盘患者。根据储存量将PABD储存量分为四组，并比较异体输血使用频率。
共有124例患者（46.1%）接受了PABD，12例患者（4.5%）接受了异体输血。每年浪费的PABD平均量为23940毫升。1至300毫升组的异体输血利用率（17.2%）显著高于301至600毫升组（1.69%）、601至900毫升组（3.82%）和901至1200毫升组（0%）（P<0.05）。避免异体输血的PABD临界量为300毫升，多因素分析中PABD≤300毫升的优势比为14.3（95%置信区间1.3 - 149.3；P = 0.03）。最大手术用血预定量为2.16单位（432毫升），手术用血预定方程为2.15单位（430毫升）。
600毫升组与PABD储存量较高的组之间异体输血利用率无差异；因此，储存600毫升PABD适用于前置胎盘和低置胎盘手术。
