REDUCTION IN THE HOMOLOGOUS BLOOD REQUIREMENT FOR ABDOMINAL AORTIC-ANEURYSM REPAIR BY THE USE OF PREADMISSION AUTOLOGOUS BLOOD DONATION

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.