Advertisement

Predeposit autologous donation in spinal surgery: a multicentre study

  • José A GarcÍa-Erce
  • VÍctor Manuel Solano
  • Jorge Cuenca
  • Javier Vicente-Thomas
  • Manuel Muñoz
  • Elvira Bisbe
  • Sandra Beltrán
  • Aina Ruiz
  • Montserrat Sáez

Abstract

Background. Allogeneic blood transfusions (ABT) are often necessary in elective spine surgery because of perioperative blood loss. Preoperative autologous blood donation (PABD) has emerged as the principal means to avoid or reduce the need for ABT. Consequently, a multicentre study was conducted to determine the yield and efficacy of PABD in spine surgery and the possible role of recombinant human erythropoietin (EPO) in facilitating PABD.

Methods. We retrospectively reviewed the hospital charts and blood bank records from all consecutive spine surgery patients who were referred for PABD. Data were obtained from two A-category hospital blood banks and one general hospital. Although we collected data from 1994, the analytic study period was from the last quarter of 1995 to December 2003. Fifty-four (7%) out of 763 patients referred for PABD were rejected, and medical records were available for 680 patients who were grouped into spinal fusion (556; 82%) and scoliosis surgery (124;18%). EPO was administered to 120 patients (17.6%). From 1999 to 2003, PABD steadily increased from 60 to 209 patients per year. Results. Overall, 92% of the patients were able to complete PABD, 71% were transfused, and almost 80% avoided ABT. PABD was more effective in fusions (86%) than in scoliosis (47%). Blood wastage was 38%, ranging from 18% for scoliosis to 42% for fusions. EPO allowed the results in the anaemic patients to be improved.

Conclusions. Therefore, despite the limitations of this retrospective study, we feel that PABD is an excellent alternative to ABT in spine surgery. However, the effectiveness of PABD may be enhanced if associated with other blood-saving techniques.

Keywords

Autotransfusion Predeposit autologous donation Scoliosis Spinal surgery Erytropoeitin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Berenholtz SM, Pronovost PJ, Mullany D, Garret E, Ness PM, Dorman T, Klag MJ (2002) Predictors of transfusion for spinal surgery in Maryland, 1997 to 2000. Transfusion 42:183–189CrossRefPubMedGoogle Scholar
  2. 2.
    Brecher ME, Goodnough LT (2001) The rise and fall of preoperative autologous blood donation (editorial). Transfusion 41:1459–1462CrossRefPubMedGoogle Scholar
  3. 3.
    Brecher ME, Goodnough LT (2002) Preoperative autologous blood donation in Europe. Transfusion 42:1615CrossRefGoogle Scholar
  4. 4.
    Cha CW, Deible C, Muzzonigro T, Lopez-Plaza I, Vogt M, Kang JD (2002) Allogenic transfusion requirements after autologous donations in posterior lumbar surgeries. Spine 27: 99–104CrossRefPubMedGoogle Scholar
  5. 5.
    Farrugia A (2004) The mantra of blood safety: time for a new tune? Vox Sang 86:1–7CrossRefPubMedGoogle Scholar
  6. 6.
    Fernandez MC, Gottlieb M, Menitove JE (1992) Blood transfusion and postoperative infection in orthopedic patients. Transfusion 32:318–322CrossRefPubMedGoogle Scholar
  7. 7.
    Goldman M, Savard R, Long A, Gélinas S, Germain M (2002) Declining value of preoperative autologous donation. Transfusion 42:819–823CrossRefPubMedGoogle Scholar
  8. 8.
    Goodnough LT, Marcus RE (1992) Effect of autologous donation in patients undergoing elective spine surgery. Spine 17:172–175PubMedGoogle Scholar
  9. 9.
    Johnson RG, Murphy M, Miller M (1989) Fusions and transfusions: an analysis of blood loss and autologous replacement during lumbar fusions. Spine 14:358–362PubMedGoogle Scholar
  10. 10.
    Lee JH, Lee SH, Oh JH (2003) Minimal effective dosage of recombinant human erythropoietin in spinal surgery. Clin Orthop 412:71–76PubMedGoogle Scholar
  11. 11.
    Lo KS, Chow BF, Chan HT, Gunawardene S, Luk KD (2002) An autologous blood donation program for paediatric scoliosis in Hong Kong. Anesth Intensive Care 30(6):775–781CrossRefGoogle Scholar
  12. 12.
    Meert KL, Kannan S, Mooney JF (2002) Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery. Spine 27:2137–2142CrossRefPubMedGoogle Scholar
  13. 13.
    Moran MM, Kroon D, Tredwell SJ, Wadsworth LD (1995) The role of autologous blood transfusion in adolescents undergoing spinal surgery. Spine 20:532–536PubMedGoogle Scholar
  14. 14.
    Muñoz Gómez M, GarcÍa Vallejo JJ, López-Andrade Jurado A, Gómez Luque A, Ruiz Romero de la Cruz MD, Maldonado Eloy-GarcÍa J (2001) Autotransfusión postoperatoria en cirugÍa ortopédica. Un análisis de la calidad, seguridad y eficacia de la sangre recuperada de los drenajes postoperatorios. Rev Esp Anestesiol Reanim 48:131–140PubMedGoogle Scholar
  15. 15.
    Muñoz M, GarcÍa-Erce JA (2002) Preoperative autologous blood donation in Europe. Transfusion 42:1614CrossRefPubMedGoogle Scholar
  16. 16.
    Murray DJ, Forbes RB, Titone MB, Weinstein SL (1997) Transfusion management in pediatric and adolescent scoliosis surgery. Efficacy of autologous blood. Spine 22:2735–2740CrossRefPubMedGoogle Scholar
  17. 17.
    Oga M, Ikuta H, Sugioka Y (1992) The use of autologous blood in the surgical treatment of spinal disorders. Spine 17:1381–1385PubMedGoogle Scholar
  18. 18.
    Ridgeway S, Tai C, Alton P, Barnardo P, Harrison DJ (2003) Pre-donated autologous blood transfusion in scoliosis surgery. J Bone Joint Surg Br 85:1032–1036CrossRefPubMedGoogle Scholar
  19. 19.
    Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM et al. (2003) Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 43:459–469CrossRefPubMedGoogle Scholar
  20. 20.
    Sebastián C, Romero R, Olalla E, Ferrer C, GarcÍa-Vallejo JJ, Muñoz M (2000) Postoperative blood salvage and reinfusion in spinal surgery: blood quality, effectiveness and impact on patient blood parameters. Eur Spine J 9:458–465CrossRefPubMedGoogle Scholar
  21. 21.
    Sebastián C, Romero R, Olalla E, GarcÍa-Vallejo JJ, Gutiérrez J, Muñoz M (2001) Autotransfusión en cirugiá de columna lumbar. Efectividad y rendimiento de un programa con donación prepereratoria a corto plazo y/o recuperación postoperatoria de sangre autóloga. Rev Ortop Traumatol 6:502–511Google Scholar
  22. 22.
    Seltzer DG, Brown MD, Tompokins JS, Enger I, Cammisa FP Jr (1993) Toward the elimination of homologous blood use in elective lumbar spine surgery. J Spinal Disord 6:412–421PubMedGoogle Scholar
  23. 23.
    Shapiro GS, Boachie-Adjei O, Dhawlikar SH, Maier LS (2002) The use of epoetin alfa in complex spine deformity surgery. Spine 2067–2071Google Scholar
  24. 24.
    Shulman G, Solanski DR, Nicodemus CL, Flores IM, Hadjipavlou AG (1998) Audit of autotransfusion in spine surgery. Int Orthop 22:303–307CrossRefPubMedGoogle Scholar
  25. 25.
    Sonnenberg FA, Gregory P, Yomtovian R, Russel LB, Tiernay W, Kosmin M, Carson JL (1999) The cost-effectiveness of autologous transfusion revisited: implications of an increased bacterial infection with allogeneic transfusion. Transfusion 39:808–817CrossRefPubMedGoogle Scholar
  26. 26.
    Triulzi DJ, Vanek K, Ryan DH, Blumberg N (1992) A clinical and immunologic study of blood transfusion and postoperative infection in spinal surgery. Transfusion 32:517–524CrossRefPubMedGoogle Scholar
  27. 27.
    Vamvakas EC (2002) Possible mechanisms of allogeneic blood transfusionassociated postoperative infection. Transfus Med Rev 18:144–160CrossRefGoogle Scholar
  28. 28.
    Vamvakas EC, Blajchman MA (2001) Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood 97:1180–1195CrossRefPubMedGoogle Scholar
  29. 29.
    Vanderlinde ES, Heal JM, Blumberg N (2002) Autologous transfusion. Br Med J 324:772–775Google Scholar
  30. 30.
    Vitale MG, Levy DE, Park MC, Choi H, Choe JC, Roye DP (2002) Quantifying risk of transfusion in children undergoing spine surgery. Spine J 2:166–172CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • José A GarcÍa-Erce
    • 1
  • VÍctor Manuel Solano
    • 1
  • Jorge Cuenca
    • 1
  • Javier Vicente-Thomas
    • 1
  • Manuel Muñoz
    • 2
  • Elvira Bisbe
    • 3
  • Sandra Beltrán
    • 3
  • Aina Ruiz
    • 3
  • Montserrat Sáez
    • 4
  1. 1.Department of Haematology and HaemotherapyHospital “Universitario” Miguel ServetZaragozaSpain
  2. 2.GIEMSA, School of MedicineUniversidad de MálagaMálagaSpain
  3. 3.Hospital Universitario Mar-l’Esperança, IMASBarcelonaSpain
  4. 4.Banc de Sang CSI - Hospital Sant PauBarcelonaSpain

Personalised recommendations