Adams H A, Wittschier G, Fuhr R, Baltes-Götz B
Zentrum Anästhesiologie-Anästhesiologie, Medizinische Hochschule Hannover.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 May;32(5):283-90. doi: 10.1055/s-2007-995056.
This study was undertaken to investigate the efficiency of autologous blood donation (ABD) with regard to saving of homologous transfusion, to determine the reasons for exclusion from donations and the rate of incidents during the procedure, and to investigate the quality of autologous fresh frozen plasma (AFFP).
During an observation period of 4.5 years, all patients scheduled for elective orthopaedic hip and knee replacement were included. A period of 4 years was evaluated retrospectively, and the last half year was evaluated prospectively.
Among a collective of 710 patients, 55 (8%) non-donors and 655 (92%) donors with a total number of 1592 ABD were found. Mean age of non-donors with hip surgery was significantly higher than that of donors (72 vs. 64 years), the same was observed in patients with knee surgery (71 vs. 68 years). In the hip surgery group, 11 of 338 patients were non-donors (3%), compared with 44 of 372 patients with knee surgery (12%). In the prospective part of the study, 7% of 121 patients were non-donors. Reasons for exclusion from donation were 5 times of medical and 4 times of organisational nature. In donors for hip surgery, a mean of 3.0 units was collected, compared with 1.9 units in donors for knee surgery. On the day before operation, mean haemoglobin concentrations were similar in donors and non-donors. During ABD, 11 incidents were observed, representing 0.69% of all ABD, 83.5% of 327 donors with hip surgery left the hospital without any transfusion of homologous blood, 16.5 of donors with hip surgery received one or more homologous transfusions, compared with 100% of non-donors (p < 0.001). In knee surgery, 93.3% of donors and 63.6% of non-donors required no homologous blood, whereas 6.7% of donors and 36.4% of non-donors received one or more homologous transfusions (p < 0.001). 529 of 2850 autologous blood units (19%) were not transfused, and 19 of these units were rejected due to technical or organisational problems. In 97 patients with 240 ABD and 240 AFFP, prothrombine time, fibrinogen concentration and AT III in defrosted AFFP exceeded 70% of the values determined before ABD.
ABD is a safe procedure in almost all, even elderly, patients scheduled for elective orthopaedic hip or knee replacement in both types of operations, ABD reduces the risk of homologous transfusion significantly. A number of 3-4 units is necessary for total hip replacement, whereas 2 units are sufficient for partial or total knee replacement. Haemostatic quality of AFFP meets the requirements of fresh frozen homologous plasma.
本研究旨在调查自体输血（ABD）在节省异体输血方面的效果，确定被排除在献血之外的原因以及该过程中的事件发生率，并研究自体新鲜冰冻血浆（AFFP）的质量。
在4.5年的观察期内，纳入所有计划进行择期骨科髋关节和膝关节置换手术的患者。对4年的时间段进行回顾性评估，对最后半年进行前瞻性评估。
在710例患者中，发现55例（8%）未献血者和655例（92%）献血者，共进行了1592次自体输血。髋关节手术未献血者的平均年龄显著高于献血者（72岁对64岁），膝关节手术患者中也观察到同样情况（71岁对68岁）。在髋关节手术组中，338例患者中有11例（3%）未献血，而膝关节手术的372例患者中有44例（12%）未献血。在研究的前瞻性部分，121例患者中有7%为未献血者。被排除在献血之外的原因有5次是医疗性质的，4次是组织性质的。髋关节手术献血者平均采集3.0单位血液，膝关节手术献血者平均采集1.9单位血液。手术前一天，献血者和未献血者的平均血红蛋白浓度相似。在自体输血过程中，观察到11起事件，占所有自体输血的0.69%，83.5%的327例髋关节手术献血者出院时未输注任何异体血，16.5%的髋关节手术献血者接受了一次或多次异体输血，而未献血者为100%（p<0.001）。在膝关节手术中，93.3%的献血者和63.6%的未献血者不需要异体血，而6.7%的献血者和36.4%的未献血者接受了一次或多次异体输血（p<0.001）。2850个自体血单位中有529个（19%）未被输注，其中19个单位因技术或组织问题被拒收。在97例进行了240次自体输血和240次AFFP采集的患者中，解冻后的AFFP中凝血酶原时间、纤维蛋白原浓度和抗凝血酶III超过自体输血前测定值的70%。
对于计划进行择期骨科髋关节或膝关节置换手术的几乎所有患者，甚至是老年患者，自体输血都是一种安全的操作。在这两种手术中，自体输血显著降低了异体输血的风险。全髋关节置换术需要3至4单位血液，而部分或全膝关节置换术2单位就足够。AFFP的止血质量符合新鲜冰冻异体血浆的要求。
