AUGMENTED AUTOLOGOUS TRANSFUSIONS IN MAJOR RECONSTRUCTIVE SPINE SURGERY

Intraoperative autologous transfusion during major reconstructive spin e surgery decreased allogeneic red blood cell transfusions, but patien ts were exposed to significant numbers of allogeneic blood products. T his study reports a prospective study of 160 randomized patients under going major reconstructive spine surgery. Without delaying start of su rgery, 80 patients underwent hemapheresis with coincidental normovolem ic hemodilution in the operating room to sequester autologous blood co mponents. A therapeutic dose plateletpheresis product and an average o f 2 U each of freshly collected autologous red cells and fresh plasma were prepared prior to surgical incision. The same supplies and equipm ent were used subsequently to carry out intraoperative autologous tran sfusion (IAT). Autologous plasma and platelets were transfused to Sequ estration patients, contributing to a significant decrease of total al logeneic donor exposures. One or more autologous red blood cell unit e quivalents were cost effectively salvaged and retransfused to 78% of t he Sequestration patients. Altogether, autologous red cells comprised 87% of the total red cells transfused. During the same time period, 80 age-, sex-, and weight-matched controls, who received IAT only, were accrued for comparison with Sequestration patients. Of all red cells t ransfused to control patients, autologous units comprised 47%. Both pa tient groups received the same total perioperative red blood cell supp ort. The per patient cost for IAT, with or without sequestration, was competitive with supplying one unit of cross-matched allogeneic red ce lls. IAT only patients had greater allogeneic blood donor exposures th an Sequestration patients, in whom the numbers of allogeneic red cells , plasma and platelet transfusions were decreased. Compared with IAT a lone, the hospital post-operative stay of Sequestration patients was 2 3% less than IAT only patients. J. Clin. Apheresis 13:62-68, 1998. (C) 1998 Wiley-Liss, Inc.