Tasaki T, Ohto H, Noguchi M, Motoki R, Kikuchi S, Sato A, Hoshino S
Blood Transfusion Service, Fukushima Medical College, Japan.
Transfusion. 1994 Apr;34(4):337-43. doi: 10.1046/j.1537-2995.1994.34494233583.x.
The importance of autologous blood donation for elective surgery is recognized, and the method is being used at many hospitals. Not all patients are able to deposit a sufficient amount of blood before surgery because they cannot recover rapidly enough from phlebotomy-induced anemia. The ability to donate sufficient blood for autologous use was studied in patients who are particularly susceptible to phlebotomy-induced anemia.
Of 840 patients who donated blood for autologous use in elective surgery from November 1987 through May 1993, 20 with rheumatoid arthritis, 24 with iron deficiency anemia, and 37 aged 65 years and above with normocytic anemia were compared with 24 nonanemic elderly patients who donated a total of 1000 mL of blood for autologous use. Patients received iron sulfate orally and donated blood once a week until operation.
The amount of blood collected before surgery per control patient was more than that in others. Consequently, there was a tendency to allogeneic blood transfusion in patients with rheumatoid arthritis or elderly patients. The ferritin levels in controls and in patients with iron deficiency anemia during the donation period were almost within the normal range in spite of iron supplementation, which implied a good utilization of iron sulfate for erythropoiesis. On the other hand, the rise in ferritin levels in the elderly and in patients with rheumatoid arthritis suggested inappropriate iron availability for erythropoiesis and resulted in an increase in iron storage. Since an adequate endogenous erythropoietin response to phlebotomy-induced anemia was not observed in these patients, impaired erythropoietin production was considered one of the reasons for anemia.
Patients with iron deficiency anemia are able to continue donating blood for autologous use so long as they have sufficient iron supplementation. However, the elderly or those with rheumatoid arthritis occasionally fail to donate a sufficient volume of blood before surgery as a result of phlebotomy-induced anemia, which is caused in turn by impaired erythropoietin production.
自体输血对择期手术的重要性已得到认可，许多医院都在采用这种方法。并非所有患者在手术前都能储存足够的血液，因为他们无法从放血引起的贫血中快速恢复。本研究对特别容易发生放血引起贫血的患者进行自体输血能力的研究。
1987年11月至1993年5月期间，840例择期手术中进行自体输血的患者中，20例类风湿关节炎患者、24例缺铁性贫血患者、37例65岁及以上的正细胞性贫血患者，与24例非贫血老年患者（共捐献1000mL自体血）进行比较。患者口服硫酸亚铁，每周献血一次直至手术。
对照组患者术前采集的血量多于其他组。因此，类风湿关节炎患者或老年患者有接受异体输血的倾向。尽管补充了铁剂，但对照组和缺铁性贫血患者在献血期间的铁蛋白水平几乎在正常范围内，这表明硫酸亚铁对红细胞生成有良好的利用。另一方面，老年患者和类风湿关节炎患者铁蛋白水平的升高表明红细胞生成中铁的可用性不合适，导致铁储存增加。由于在这些患者中未观察到对放血引起贫血的内源性促红细胞生成素的充分反应，促红细胞生成素生成受损被认为是贫血的原因之一。
缺铁性贫血患者只要有足够的铁补充，就能继续进行自体输血。然而，老年人或类风湿关节炎患者偶尔会因放血引起的贫血而在手术前无法捐献足够量的血液，而放血引起的贫血又是由促红细胞生成素生成受损所致。
