THE ROLE OF AUTOLOGOUS BLOOD-TRANSFUSION IN THE FEDERAL-REPUBLIC-OF-GERMANY - RESULTS OF A 1993 QUESTIONNAIRE .1. THE REUNITED GERMANY

The objective of the study was to evaluate the role of autologous bloo d transfusion in current clinical practice in the Federal Republic of Germany after reunification. Methods. Questionnaires were sent to the anaesthesia departments of 684 German hospitals in January 1993. The s ample consisted of 400 randomly selected hospitals from the former Wes t Germany (''old federal states'') and 284 hospitals from the former G erman Democratic Republic (''new federal states''). Only hospitals wit h more than 25 surgical beds were included in the study. The questionn aire contained 36 questions related to (1) general information on the hospital, (2) preoperative autologous blood donation (PABD), (3) preop erative plasmapheresis, (4) isovolaemic haemodilution, (5) perioperati ve blood salvage, and (6) general management of blood transfusion. Res ults. A total of 502 completed questionnaires (73%) were returned, 305 from hospitals in the ''old federal states'' and 197 from hospitals i n the former German Democratic Republic. Nine per cent of the respondi ng hospitals were running their own transfusion services, and 56% were located in the vicinity of a regional blood bank. The overall proport ion of surgical procedures requiring perioperative blood transfusion r anged from 1% to 90% (median 10%). PABD was performed ''not at all'' i n 18%, ''rarely'' in 20% ''occasionally'' in 27%, ''frequently'' in 17 %, and ''mostly'' in 16% of the responding hospitals. The principal us e of PABD was in orthopaedic surgery and cardiac surgery (83% and 70% of the departments in question, respectively). In more than 50% of the hospitals reporting, the PABD service was run by the anaesthesia depa rtment. Patients not meeting the established criteria for homologous b lood donors were accepted for autologous blood donation ''frequently'' and ''mostly'' in 20% and 12% of the hospitals, respectively, but at most ''occasionally'' in 63% of the hospitals. Preoperative plasmapher esis was performed in 12% of the responding hospitals. Autologous fres h frozen plasma predominantly was used for volume replacement, and for prevention of coagulation disorders when major blood loss was anticip ated. Isovolaemic haemodilution was performed ''not at all'' in 28%, ' 'rarely'' in 19%, ''occasionally'' in 28%, ''frequently'' in 16%, and ''mostly'' in 8% of the responding hospitals. The reasons most frequen tly invoked for not performing haemodilution were ''too time consuming '' and ''too little blood-saving effect''. Cell separators for periope rative blood salvage were available in 30% of the responding hospitals . Of the other hospitals not equipped with cell-washing devices, 11% p erformed perioperative blood salvage of unprocessed blood by means of simple collection devices. Some 80% of those hospitals using intraoper ative autotransfusion devices also performed blood salvage postoperati vely. The principal use of perioperative blood salvage was in cardiac surgery, orthopaedics, and vascular surgery (90%, 54%, and 54% of depa rtments, respectively). Some 48% of the responding anaesthetists ''mos tly'' considered haemoglobin levels of 8-10 g/dl acceptable in patient s without cardiopulmonary disease, but only 18% did so in patients wit h cardiopulmonary disease. Conclusions. Although available in the majo rity of hospitals surveyed, the simple techniques of both PABD and iso volaemic haemodilution are unduly neglected in routine clinical practi ce. The consistent use of both of these techniques, and the careful we ighing up of the indication for every single blood transfusion, would not only effectively reduce homologous blood transfusions, but also en able even small hospitals to run successful autologous transfusion pro grammes without expensive cell-washing and plasmapheresis devices.