TOWARD THE ELIMINATION OF HOMOLOGOUS BLOOD USE IN ELECTIVE LUMBAR SPINE SURGERY

Two hundred twenty-four consecutive patients underwent elective poster ior lumbar spinal surgery over a 3 1/2-year span at the University of Miami/Jackson Memorial Medical Center. Patients ranged in age from 17 to 87 years, and 58% were male. Fifty-eight patients underwent revisio n surgery, and 65 patients required fusions, including 35 necessitatin g internal fixation. One hundred seventy-four patients (78%) were requ ested to participate in a preoperatively donated autologous blood (PDA B) program. Six of these patients were excluded from participation, an d 168 patients banked 425 U of autologous blood. Eighty percent of the patients participating in the PDAB program received some or all of th eir donated blood. Intraoperative blood salvage was used in 37% of cas es. Seven patients received homologous blood: four in addition to salv aged and donated blood, two that were unable to donate blood due to po sitive hepatitis B serology, and one erroneously. The combined use of PDAB and intraoperative salvage program allowed autologous blood repla cement to meet the total transfusion requirements of 96% of the patien ts who predeposited blood, including 94% of those undergoing spinal fu sions. Autologous blood comprised 99% of the total blood replacement u sed in this series, and 95% of the patients requiring blood transfusio ns received only autologous blood. Establishment of a protocol judicio usly using PDAB in conjunction with intraoperative blood salvage can r esult in virtual elimination of the need for homologous blood transfus ion in elective lumbar spine surgery.