Mercuriali F, Inghilleri G
Gaetano Pini Orthopedic Institute, Milan, Italy.
Curr Med Res Opin. 1996;13(8):465-78. doi: 10.1185/03007999609115227.
Autologous blood donation (ABD) reduces both the real and perceived risks of allogeneic blood exposure, although wasted units increase overall costs. Wastage of autologous blood can be contained by using rational blood ordering and collection strategies. These identify procedures with transfusion requirements, utilizing ABD predeposit in patients undergoing surgery for which the need for blood transfusion has been clearly established, and where the average blood loss for each procedure has been determined. ABD programmes can be optimized by adopting a personalized approach for each individual patient. The predicted and tolerated blood loss is calculated for each patient, and the difference between the two determines the patient's transfusion need. Taking into account the type of surgery, time to surgery and the clinical condition of the patient, the best and most cost-conscious transfusion strategy can then be determined. Options include: reducing the blood loss pharmacologically, transfusing allogeneic blood, using autologous blood from a variety of techniques, using recombinant erythropoietin (epoetin alfa) to increment baseline haematocrit (Hct) or to increase the volume of predonated blood, and using blood substitutes in addition to autotransfusion techniques. Autotransfusion techniques available include ABD predeposit, normovolaemic haemodilution and perioperative salvage. ABD predeposit may be limited by the delay in the natural erythropoietic response to allow recovery of red cells collected. Together with adequate iron support, epoetin alfa accelerates recovery of the Hct and increases the tolerated blood loss. The availability and judicious use of these blood conservation strategies provide for both effective and cost-conscious blood transfusion strategies.
自体血捐献（ABD）可降低异体输血的实际风险和感知风险，尽管废弃的血单位会增加总体成本。通过采用合理的用血预订和采集策略，可以控制自体血的浪费。这些策略可识别有输血需求的手术，在已明确输血需求且已确定每种手术平均失血量的手术患者中使用ABD预存血。通过对每位患者采取个性化方法，可以优化ABD方案。为每位患者计算预计失血量和可耐受失血量，两者之差决定患者的输血需求。考虑到手术类型、距手术的时间以及患者的临床状况，然后可以确定最佳且最具成本效益的输血策略。选项包括：通过药物减少失血量、输注异体血、使用多种技术采集的自体血、使用重组促红细胞生成素（促红细胞生成素α）提高基线血细胞比容（Hct）或增加预存血量，以及在自体输血技术之外使用血液替代品。可用的自体输血技术包括ABD预存血、等容血液稀释和围手术期血液回收。ABD预存血可能会受到自然红细胞生成反应延迟的限制，以允许回收采集的红细胞。与充足的铁支持一起，促红细胞生成素α可加速Hct的恢复并增加可耐受失血量。这些血液保护策略的可用性和明智使用为有效且具成本效益的输血策略提供了保障。
