CONFIRMATION OF THE SAFETY OF AUTOLOGOUS BLOOD DONATION BY PATIENTS AWAITING HEART OR LONG TRANSPLANTATION - A CONTROLLED-STUDY USING HEMODYNAMIC MONITORING

Background: Though earlier investigations have demonstrated the effica cy of autologous blood transfusion in reducing allogeneic blood exposu re in patients undergoing heart or lung transplantation, questions rem ain regarding the safety of blood donation by patients with severe hea rt or lung disease, Methods: Response to autologous blood donation by candidates for heart and lung transplantation and a group of age- and gender-matched control subjects was studied, Heart rate, blood pressur e, oxygen saturation, and cardiac rhythm were examined before and afte r phlebotomy, and response to orthostatic challenge was evaluated, Pat ients were also questioned regarding impressions of changes in subject ive sense of well being. Differences between patients and control subj ects were evaluated by the paired t test and Fisher's exact test, An a lpha of 0.05 was used in all testing to determine statistical signific ance, Results: Eighteen candidates for heart transplantation, 16 candi dates for lung transplantation, and their matched control subjects wer e studied, Though patients and control subjects differed with respect to baseline hemodynamic measurements, significant differences between the groups' responses to phlebotomy were not observed, After whole blo od donation, orthostatic challenge resulted in a mean change in mean a rterial pressure of -2.1 mm Hg in candidates for heart transplantation compared with a mean of +3.6 mm Hg in their control subjects (p = 0.0 62), In candidates for lung transplantation there was a mean change of +2.2 mm Hg after orthostatic challenge versus a mean change of +8.5 m m Hg in their control subjects (p = 0.052), Furthermore, no changes in cardiac rhythm or arterial oxygen saturation were detected, Conclusio ns: The hemodynamic effects of autologous blood donation in a group of patients with significant cardiac or pulmonary disease were not diffe rent from those observed in patients considered acceptable candidates for autologous blood collection, On the basis of these objective findi ngs, we believe that patients with less severe degrees of heart or lun g disease should not be excluded from participation in autologous bloo d donation programs.