INTRAOPERATIVE AUTOLOGOUS BLOOD DONATION PRESERVES RED-CELL MASS BUT DOES NOT DECREASE POSTOPERATIVE BLEEDING

Background. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. The benefit of the acu te removal and reinfusion of fresh autologous blood around the time of cardiopulmonary bypass - a technique known as intraoperative autologo us donation (IAD) - has not been universally accepted. We sought to mo re clearly evaluate the effects of IAD on allogeneic transfusion and p ostoperative bleeding by removing, preserving, and reinfusing a calcul ated maximum volume of fresh autologous whole blood. Methods. Ninety p atients undergoing coronary artery bypass grafting or valvular operati ons were prospectively randomized to either have (IAD group) or not ha ve (control group) calculated maximum volume IAD performed. Treatment was otherwise identical. Transfusion guidelines were uniformly applied to all patients. Results. An average volume of 1,540 +/- 302 mt of fr esh autologous blood was removed and reinfused in the IAD group. Posto perative hematocrits were significantly greater at 12 and 24 hours pos toperatively in the IAD group versus the control group despite a signi ficant decrease in both the percentage of patients in whom allogeneic red blood cells were transfused (17% versus 52%; p < 0.01) and the num ber of red blood cell units transfused per patient per group (0.28 +/- 0.66 and 1.14 +/- 1.19 units; p < 0.01). Conversely, chest tube outpu t, incidence of excessive postoperative bleeding, postoperative prothr ombin time, and platelet and coagulation factor transfusion requiremen t did not differ between groups. Conclusions. These results indicate t hat intraoperative autologous donation serves to preserve red blood ce ll mass. Its routine use in eligible patients is therefore justified. However, the removal and reinfusion of an individually calculated maxi mum volume of fresh autologous blood had no effect on postoperative bl eeding or platelet and coagulation factor transfusion requirement. Thi s lack of hemostatic effect belies the beliefs of many about the prima ry action of IAD, helps to delineate the optimal way in which to perfo rm IAD, and carries implications regarding the use of allogeneic plate let and coagulation factors for the treatment of early postoperative b leeding.