Bernstein L H, Coles M, Viner N
Department of Pathology, Bridgeport Hospital, CT 06610, USA.
Yale J Biol Med. 1995 Sep-Dec;68(5-6):207-13.
The safety of the blood supply, an issue in the 1970s and 1980s, created an increased need to screen the blood supply for HIV-1 and hepatitis C virus infections. The possibility exists that other contamination could again affect the blood supply. This has resulted in the increased use of strategies to minimize the transfusion of allogeneic blood, such as autologous blood predeposit for elective surgical procedures. Many studies indicate, however, that autologous blood donation is overutilized so that half of the blood withdrawn for autologous use is discarded. Cost-effectiveness studies have indicated that autologous blood donation has little benefit compared with many medical procedures, from which one might conclude that the procedure could be eliminated. Alternatively, the benefit could be improved by reducing the wastage of autologous donated blood. This wastage must occur only because of a premise that autologous blood is obtained to ensure avoidance of a homologous transfusion. This results in an amount of blood withdrawn that is more than is used in an uncomplicated procedure. We examined the transfusion requirements in surgical procedures for which there is autologous blood donation to establish the optimum amount of blood to be taken based on expected blood use. The transfusion records of 493 patients who donated blood preoperatively (340 orthopedic, 69 urological and 83 gynecological, in the years 1992 and 1993) were audited to determine the characteristics of the transfusion practices associated with the surgical procedures. The study sample underwent 182 total knee and 123 total hip arthroplasties, 33 laminectomies with fusion and three without, 83 hysterectomies and myomectomies, 59 radical retropubic prostatectomies and 10 nephrectomies and lymph node resections. Data used for evaluation were age, sex, units donated and transfused, predonation hemoglobin concentration, initial and final hemoglobin concentration, surgical procedure and surgical blood loss. The study suggests that autologous predeposit is not indicated for hysterectomies because of the low likelihood of transfusion. Even when a transfusion is likely according to the surgical blood order schedule, predonation is greater than actual use. Use of predonation hemoglobin could facilitate better efficiency of use for procedures where use is anticipated, thereby significantly reducing a wastage near 50 percent.
血液供应安全在20世纪70年代和80年代曾是个问题，这使得筛查血液供应中是否感染HIV-1和丙型肝炎病毒的需求增加。存在其他污染再次影响血液供应的可能性。这导致了尽量减少异体输血策略的更多使用，比如为择期手术预先储存自体血。然而，许多研究表明，自体血捐献被过度使用，以至于为自体使用而采集的血液有一半被丢弃。成本效益研究表明，与许多医疗程序相比，自体血捐献益处不大，由此人们可能得出可以取消该程序的结论。或者，可以通过减少自体捐献血液的浪费来提高益处。这种浪费肯定只是因为一个前提，即采集自体血是为了确保避免异体输血。这导致采集的血液量超过了简单手术所需的量。我们检查了有自体血捐献的手术程序中的输血需求，以根据预期的用血情况确定最佳采血量。对1992年和1993年术前献血的493例患者（340例骨科、69例泌尿科和83例妇科）的输血记录进行了审核，以确定与手术程序相关的输血实践特征。研究样本包括182例全膝关节置换术和123例全髋关节置换术、33例有融合的椎板切除术和3例无融合的椎板切除术、83例子宫切除术和肌瘤切除术、59例耻骨后根治性前列腺切除术以及10例肾切除术和淋巴结切除术。用于评估的数据包括年龄、性别、捐献和输注的单位数、献血前血红蛋白浓度、初始和最终血红蛋白浓度、手术程序和手术失血量。该研究表明，由于输血可能性低，子宫切除术不适合进行自体血预先储存。即使根据手术用血预约计划可能需要输血，预先储存的血量也超过了实际用量。使用献血前血红蛋白可以提高预期需要用血的手术程序的使用效率，从而显著减少近50%的浪费。
