Pj. Ohara et al., REDUCTION IN THE HOMOLOGOUS BLOOD REQUIREMENT FOR ABDOMINAL AORTIC-ANEURYSM REPAIR BY THE USE OF PREADMISSION AUTOLOGOUS BLOOD DONATION, Surgery, 115(1), 1994, pp. 69-76
Background. To evaluate the effectiveness of preadmission autologous b
lood donation (PABD) in reducing the homologous transfusion requiremen
t of abdominal aortic aneurysm resection, the blood product requiremen
ts of 145 patients who underwent operation at Cleveland Clinic from Se
ptember 1987 through May 1997 were reviewed. Methods. A study group of
73 patients underwent aortic grafting for aneurysm after PABD. Intrao
perative autotransfusion (IAT) was used routinely. Homologous blood re
quirements were compared to those of 72 patients at the same center wh
o underwent similar operations using IAT alone. No significant differe
nces were noted in age, gender, cardiovascular risk factors, operation
complexity, intraoperative blood loss, or IAT volumes between the two
groups. Mean aneurysm size of the study patients (5.4 cm) was slightl
y less than that of the comparison patients (6.0 cm) (p less than or e
qual to 0.001). Patients in the study group received a mean of 1.9 uni
ts predeposited autologous blood. Results. The mean discharge hematocr
it (33.4%) and hemoglobin (11.0 gm/dl) levels of the study group were
indistinguishable pam those of the comparison group (33.3% and 11.1 gm
/dl, respectively). The homologous blood requirement of the study grou
p was significantly less (median, 0; mean, 1.3 units/patient) than tha
t of the comparison group (median, 1.5; mean, 1.9 units/patient) (p =
0.001). Furthermore, 67% (49 of 73 patients) of the study group requir
ed no homologous blood although only 36% (26 of 72 patients) of the co
mparison patients avoided banked blood transfusions (p = 0.0004). No s
ignificant differences were found in platelet, fresh frozen plasma, or
cryoprecipitate requirements between the study and comparison groups.
Conclusions. PABD significantly reduces the homologous blood requirem
ents for elective aortic aneurysm resection and, when used in combinat
ion with IAT, eliminates the need for homologous blood in at least two
thirds properly selected patients.