Effects of different techniques of autologous transfusion

Clinical outcomes of observational studies of autologous versus allogeneic blood transfusions
 

Table A Effects of different techniques of autologous transfusion
 

 
Predeposit autologous donation
Normovolaemic haemodilution
Intraoperative/postoperative salvage
Positive    
Minimises transfusion transmitted disease
Yes
Yes
Yes
Minimises red cell alloimmunisation
Yes
Yes
Yes
Provides compatible blood for patients with alloantibodies or rare red cell phenotypes
Yes
Yes
Yes
Reduces incidence of febrile or allergic reactions
Yes
Yes
Yes
Reduces risk of ABO incompatibility
Yes
Yes
Yes
Reduces risk of postoperative infection or cancer recurrence
Probably
Probably
Probably
Reduces risk of bacterial contamination
No
Yes
Yes
Reduces risk of volume overload
No
No
Yes
Autologous donation process risk free
No
No
Yes
Almost all patients eligible
No
Yes
Yes
Lends itself to both elective and non-elective surgery
No
Yes
Yes
Need for allogeneic blood eliminated
No
No
No
Reduces allogeneic blood exposure
Yes
Yes
Yes
Haemostatic potential of transfused blood remains intact
No
Yes
No
Supplements allogeneic blood supply
Yes
Yes
Yes
May be used in patients with systemic infection
No
Yes
No
Less costly than allogeneic transfusion
No
Yes
No
Negative   
Subjects patients to anaemia
Yes
Yes
No
Inconvenient for patients
Yes
No
No
Wastage
Up to 50%
Minimal
Minimal

 

Table B Clinical outcomes of observational studies of autologous versus allogeneic blood transfusions
 

     
% of cases developing complications after transfusion
 
Study
No of patients
Type of surgery
Intervention
Type of complication
Autologous
Allogeneic
P value for reduction in postoperative complications
Murphy et al, 19911
84
Orthopaedic
Pre-A
Infection
3
32
0.0029
Triulzi et al, 19922
109
Orthopaedic
Pre-A
Infection
4
21
0.0185
Fernandez et al, 19923
376
Orthopaedic
Pre-A
Infection
5
7
NS
Mezrow et al, 19924
100
Varied
Pre-A
Infection
4
16
<0.05
Howard et al, 19935
303
Orthopaedic
Pre-A
Infection
20
28
NS
Vamvakas et al, 19956
420
Orthopaedic
Pre-A
Infection
6
10
NS
Cousin et al, 19947
86
Cardiac
Pre-A
Infection
C
C
-

<0.01

Vignali et al, 19958
161
Colorectal
Pre-A
Infection
14
33
<0.001
Chan et al, 19989
379
Liver
Pre-A
Multiple
38
20
<0.01
Bierbaum et al, 199910
4409
Orthopaedic
Pre-A
Infection
4
7
<0.05
Sauaia et al, 199911
451
Varied
Pre-A
Infection
5
7
NS
Kinoshita et al, 200012
348
Oesophageal
Pre-A/E
Infection
11
27
0.008
Shinozuka et al, 200013
46
Liver
Pre-A/E
Multiple
17
47
<0.05
Borghi et al, 200014
2884
Orthopaedic
Pre-A/I-A
Multiple
7
30
<0.0005
Body et al, 199915
617
Cardiac
P-A
Infection
6
7
0.81
Bae et al, 200116
2043
Orthopaedic
Pre-A
Deep vein thrombosis
9
14
0.003

Abbreviations: Pre-A=predeposit autologous transfusion; E=erythropoietin; I-A=intraoperative salvage; P-A=postoperative salvage.

Extra web references:

  1. Murphy P, Heal JM, Blumberg N. Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions. Transfusion 1991;31:212-7.
  2. Triulzi DJ, Vanek K, Ryan DH, Blumberg N. A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 1992;32:517-24.
  3. Fernandez MC, Gottlieb M, Menitove JE. Blood transfusion and postoperative infection in orthopedic patients. Transfusion 1992;32:318-22.
  4. Mezrow CK, Bergstein I, Tartter PI. Postoperative infections following autologous and homologous blood transfusions. Transfusion 1992;32:27-30.
  5. Howard HL, Rushambuza FG, Martlew VJ, Satchi G, Bolton-Maggs B. Clinical benefits of autologous blood transfusion: An objective assessment. Clin Lab Haematol 1993;15:165-71.
  6. Vamvakas EC, Moore SB, Cabanela M. Blood transfusion and septic complications after hip replacement surgery. Transfusion 1995;35:150-6.
  7. Cousin MT. Bacterial infection rate after cardio-pulmonary bypass--effects of autologous and homologous transfusions. Annales de Chirurgie 1994;48:818-24.
  8. Vignali A, Braga M, Dionigi P, Radaelli G, Gentilini O, Bellini A, et al. Impact of a programme of autologous blood donation on the incidence of infection in patients with colorectal cancer. Eur J Surg 1995;161:487-92.
  9. Chan ACW, Blumgart, L.H., Wuest, D.L., Melendez, J.A., Fong, Y. Use of preoperative autologous blood donation in liver resections for colorectal metastases. Am J Surg 1998;175:461-5.
  10. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81A:2-10.
  11. Sauaia A, Alexander W, Moore EE, Stevens BR, Rosen H, Dunn TR. Autologous blood transfusion does not reduce postoperative infection rates in elective surgery. Am J Surg 1999;178:549-54.
  12. Kinoshita Y, Udagawa H, Tsutsumi K, Ueno M, Nakamura T, Akiyama H, et al. Usefulness of autologous blood transfusion for avoiding allogenic transfusion and infectious complications after esophageal cancer resection. Surgery 2000;127:185-92.
  13. Shinozuka N, Koyama I, Arai T, Numajiri Y, Watanabe T, Nagashima N, et al. Autologous blood transfusion in patients with hepatocellular carcinoma undergoing hepatectomy. Am J Surg 2000;179:42-5.
  14. Borghi B, Casati A. Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. Eur J Anaesthesiol 2000;17:411-7.
  15. Body SC, Birmingham J, Parks P, Ley C, Maddi R, Shernan SK, et al. Safety and efficacy of shed mediastinal blood transfusion after cardiac surgery: A multicenter observational study. J Cardiothorac Vasc Anesth 1999;13:410-6.
  16. Bae H, Westrich GH, Sculco TP, Salvati EA, Reich LM. The effect of preoperative donation of autologous blood on deep-vein thrombosis after total hip arthroplasty. J Bone Joint Surg Br 2001;83:676-9.