ADVANTAGES AND LIMITATIONS OF INTRAOPERAT IVE AUTOTRANSFUSION (MAT) IN RADICAL PROSTATECTOMY

Intraoperative autotransfusion (MAT), preoperative autologous blood do nation,and preoperative normovolaemic haemodilution are three differen t methods to avoid homologous blood transfusion during surgical proced ures. The controversial use of MAT via cell saver in tumour surgery as well as contamination of the operative field with urine illustrate th e particular difficulties of autologous blood transfusion in connectio n with radical prostatectomy. We investigated changes in the osmotic r esistance of the retransfused red blood cells (RBC), bacterial contami nation, changes in coagulation parameters, and the presence of tumour cells. Patients and methods: After written informed consent, 24 patien ts who presented for radical prostatectomy were randomly allocated to either a group that used MAT or a group that used homologous transfusi on. The patients received ''balanced anaesthesia'' with midazolam, fen tanyl, atracurium, and nitrous oxide/oxygen. The analysed parameters f rom the preoperative period to the 3rd postoperative day are shown in Table 1. The Haemonetics 3 Plus Cell Saver was used for autotransfusio n. Results: Our results showed that the haematologic parameters, coagu lation factors, and serum chemistry did not differ between the two gro ups (Tables 2-4). However, there were significant differences during t he investigated period. The osmotic resistance of the salvaged RBCs wa s higher than that preoperatively. Furthermore, there were no tumour c ells in the autologous salvaged RBCs. Conclusion: Our results showed n o decrease in the quality of the autotransfused RBCs, urine was not re transfused;and there were no significant differences between the group s postoperatively. Although there were no tumour cells in the salvaged blood, the possibility of blood irradiation is discussed. We conclude d that because of the risk of infection of homologous blood products, MAT is a safe possibility to reduce the amount of homologous blood tra nsfusion required in connection with radical prostatectomy.