Transfusion practice in support of surgery during introduction of a hospital-based autologous presurgical blood donor program.

OBJECTIVES

To assess blood use in support of elective surgery during the introduction of a hospital-based presurgical autologous blood donor program and to identify changes in transfusion practice.

DESIGN

Case series over a 3-year period.

SETTING

A tertiary-care, university-affiliated hospital.

PATIENTS

All patients (887) who underwent, electively, one of four major surgical procedures between Apr. 1, 1990, and Mar. 31, 1993, during introduction of the hospital's autologous blood transfusion program. The criteria for donation were wide.

INTERVENTIONS

Hip and knee arthroplasty, radical hysterectomy and radical prostatectomy.

MAIN OUTCOME MEASURES

Increase or decrease in the use of autologous or allogeneic blood for transfusion for the four surgical procedures over the study period.

RESULTS

For hip arthroplasty, the use of blood decreased significantly overall. The use of blood in support of radical hysterectomy and prostatectomy decreased but not significantly. In knee arthroplasty, blood use increased for reasons still under investigation. The contribution of autologous blood for the four procedures increased over the 3 years of the study from 17% to 55%, and constituted 3.8% of red cell and whole blood transfusions. Avoidance of allogeneic transfusion in the 3rd year of the study was 64% for patients who underwent hip arthroplasty, 71% for those who underwent radical prostatectomy and 77% for those who underwent knee arthroplasty and radical hysterectomy.

CONCLUSIONS

Hospital-based autologous blood collection with wide eligibility criteria can contribute significantly to the availability of blood for elective surgery and can prevent allogeneic blood exposure in about 75% of patients who undergo, electively, one of four common procedures. Compared with other centres, there is room for further reduction in allogeneic blood exposure.