| Popis: |
Over a period of 18 months, 313 patients (mean age 52 years) undergoing elective cardiovascular surgery were included in the autologous transfusion program involving two different Transfusion Centres. A further 10 patients were excluded because of anaemia (haemoglobin levels < 11 g · dl−1) (n = 3), angina pectoris less than 8 days before (n = 3), patient refusal (n = 2), pneumonia (n = 1), and severe aortic insufficiency (n = 1). A maximum of 5 ml · kg−1 of blood was obtained during the 3 to 4 weeks prior to surgery, one donation being taken a week. In one Transfusion Centre, the blood was taken without tourniquet, and without any fluid replacement. Diuretics and converting enzyme inhibitors were stopped. In the opposite, in the other Centre, blood was taken using a tourniquet, and replaced by a gelatin solution (Plasmion ®). All the patients were given iron. The blood units were kept by the Transfusion Centres under the same conditions as homologous blood, but in a separate circuit. The 313 patients predeposited a mean of 2.71 units of blood : 4 units where obtained in 59 patients, 3 in 113, 2 in 133 and only 1 in 8. Mean haemoglobin level on starting the program was 14.49 g · dl−1. Neither homologous red cells nor plasma was administered in 176 patients (56.23 %) ; among the 172 patients who predeposited 3 or 4 units, 123 (71.5 %) were given their own blood only. Intraoperative blood salvage was used in 189 out of 313 patients (60.4 %), and intraoperative haemodilution with albumin was used in 173 patients. This technique was not more expensive than homologous transfusion, but it ought to be used with the other techniques of blood saving. Autologous blood transfusion not only relieves the strain on the transfusion service, and saves money, but also saves time with crossmatching. Moreover, it reassures patients that they are not at risk of transfusion adverse reactions, or being infected with the AIDS or hepatitis viruses. |
