QUALITY MANAGEMENT IN AUTOLOGOUS HEMOTHER APY - RISKS OF AUTOLOGOUS BLOOD DONATIONS

Objective: Registration and documentation of adverse reactions (EBV) d uring autologous blood donations (EBS) is necessary as a matter of qua lity control. Design: We investigated with the help of data bank evalu ation if the documented re actions help to estimate the risk for undes ired side effects. All protocols with EBV were divided into grades of severity (SG 1 = no clinical relevance; SG 2 = treatment necessary; SG < 2 = in-patient treatment) and documented (data bank EBOS). Setting: Department for autologous donors as part of the clinic for anesthesio logy of a teaching hospital. Participants: 2,479 autologous blood dona tions in 598 patients between April 1993 and March 1995. Results: Duri ng 480 EBS (19.4%) we registered 617 reactions. Only in 85 donations ( 3.4%) with 121 EBV a treatment was necessary (SG 2). Hypotension (57.9 %) and bradycardia (24.8%) were the most common side effects and occur red more frequently during the first donation. Side effects occurred m ore often in female donors (70.4%) than in male donors. There was no s ignificant difference between patients with EBV and SG 2 and the total collective concerning ASA classification and age. Serious adverse rec tions (SG > 2) did not occur. Conclusions: The high rate of autologous blood donations with side effects (19.4%) reflects first of all the g ood monitoring and documentation. EBV that had to be treated occurred rarely. Hypotension and bradycardia as the most common reactions can b e explained by a relative deficit of volume and/or vasovagal reactions . Female gender and first-time donation are risk factors for these rea ctions. The lower incidence of EBV during repeated donations is possib ly an effect of performed volume replacement. A qualified monitoring o f patients during EBS helps to achieve a low rate of adverse reactions comparable to homologous donations.