Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding

Robert E. Helm, John D. Klemperer, Todd K. Rosengart, Jeffrey P. Gold, Powers Peterson, William DeBois, Nasser K. Altorki, Samuel Lang, Stephen Thomas, O. Wayne Isom, Karl H. Krieger

Research output: Contribution to journalArticle

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Abstract

Background. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. The benefit of the acute removal and reinfusion of fresh autologous blood around time of cardiopulmonary bypass-a technique known as intraoperative autologous donation (IAD)-has not been universally accepted. We sought to more clearly evaluate the effects of IAD on allogeneic transfusion and postoperative bleeding by removing, preserving, and reinfusing a calculated maximum volume of fresh autologous whole blood. Methods. Ninety patients undergoing coronary artery bypass grafting or valvular operations were prospectively randomized to either have (IAD group) or not have (control group) calculated maximum volume IAD performed. Treatment was otherwise identical. Transfusion guidelines were uniformly applied to all patients. Results. An average volume of 1,540 ± 302 mL of fresh autologous blood was removed and reinfused in the IAD group. Postoperative hematocrits were significantly greater at 12 and 24 hours postoperatively in the IAD group versus the control group despite a significant decrease in both the percentage of patients in whom allogeneic red blood cells were transfused (17% versus 52%; p < 0.01) and the number of red blood cell units transfused per patient per group (0.28 ± 0.66 and 1.14 ± 1.19 units; p < 0.01). Conversely, chest tube output, incidence of excessive postoperative bleeding, postoperative prothrombin time, and platelet and coagulation factor transfusion requirement did not differ between groups. Conclusions. These results indicate that intraoperative autologous donation serves to preserve red blood cell mass. Its routine use in eligible patients is therefore justified. However, the removal and reinfusion of an individually calculated maximum volume of fresh autologous blood had no effect on postoperative bleeding or platelet and coagulation factor transfusion requirement. This lack of hemostatic effect belies the beliefs of many about the primary action of IAD, helps to delineate the optimal way in which to perform IAD, and carries implications regarding the use of allogeneic platelet and coagulation factors for the treatment of early postoperative bleeding.

Original languageEnglish (US)
Pages (from-to)1431-1441
Number of pages11
JournalAnnals of Thoracic Surgery
Volume62
Issue number5
DOIs
StatePublished - Nov 1996

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Erythrocyte Volume
Blood Donors
Blood Coagulation Factors
Hemorrhage
Blood Platelets
Erythrocytes
Chest Tubes
Control Groups
Prothrombin Time
Hemostatics
Cardiopulmonary Bypass
Hematocrit
Coronary Artery Bypass
Guidelines
Morbidity
Costs and Cost Analysis
Incidence
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding. / Helm, Robert E.; Klemperer, John D.; Rosengart, Todd K.; Gold, Jeffrey P.; Peterson, Powers; DeBois, William; Altorki, Nasser K.; Lang, Samuel; Thomas, Stephen; Isom, O. Wayne; Krieger, Karl H.

In: Annals of Thoracic Surgery, Vol. 62, No. 5, 11.1996, p. 1431-1441.

Research output: Contribution to journalArticle

Helm, RE, Klemperer, JD, Rosengart, TK, Gold, JP, Peterson, P, DeBois, W, Altorki, NK, Lang, S, Thomas, S, Isom, OW & Krieger, KH 1996, 'Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding', Annals of Thoracic Surgery, vol. 62, no. 5, pp. 1431-1441. https://doi.org/10.1016/0003-4975(96)00755-2
Helm, Robert E. ; Klemperer, John D. ; Rosengart, Todd K. ; Gold, Jeffrey P. ; Peterson, Powers ; DeBois, William ; Altorki, Nasser K. ; Lang, Samuel ; Thomas, Stephen ; Isom, O. Wayne ; Krieger, Karl H. / Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding. In: Annals of Thoracic Surgery. 1996 ; Vol. 62, No. 5. pp. 1431-1441.
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abstract = "Background. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. The benefit of the acute removal and reinfusion of fresh autologous blood around time of cardiopulmonary bypass-a technique known as intraoperative autologous donation (IAD)-has not been universally accepted. We sought to more clearly evaluate the effects of IAD on allogeneic transfusion and postoperative bleeding by removing, preserving, and reinfusing a calculated maximum volume of fresh autologous whole blood. Methods. Ninety patients undergoing coronary artery bypass grafting or valvular operations were prospectively randomized to either have (IAD group) or not have (control group) calculated maximum volume IAD performed. Treatment was otherwise identical. Transfusion guidelines were uniformly applied to all patients. Results. An average volume of 1,540 ± 302 mL of fresh autologous blood was removed and reinfused in the IAD group. Postoperative hematocrits were significantly greater at 12 and 24 hours postoperatively in the IAD group versus the control group despite a significant decrease in both the percentage of patients in whom allogeneic red blood cells were transfused (17{\%} versus 52{\%}; p < 0.01) and the number of red blood cell units transfused per patient per group (0.28 ± 0.66 and 1.14 ± 1.19 units; p < 0.01). Conversely, chest tube output, incidence of excessive postoperative bleeding, postoperative prothrombin time, and platelet and coagulation factor transfusion requirement did not differ between groups. Conclusions. These results indicate that intraoperative autologous donation serves to preserve red blood cell mass. Its routine use in eligible patients is therefore justified. However, the removal and reinfusion of an individually calculated maximum volume of fresh autologous blood had no effect on postoperative bleeding or platelet and coagulation factor transfusion requirement. This lack of hemostatic effect belies the beliefs of many about the primary action of IAD, helps to delineate the optimal way in which to perform IAD, and carries implications regarding the use of allogeneic platelet and coagulation factors for the treatment of early postoperative bleeding.",
author = "Helm, {Robert E.} and Klemperer, {John D.} and Rosengart, {Todd K.} and Gold, {Jeffrey P.} and Powers Peterson and William DeBois and Altorki, {Nasser K.} and Samuel Lang and Stephen Thomas and Isom, {O. Wayne} and Krieger, {Karl H.}",
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T1 - Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding

AU - Helm, Robert E.

AU - Klemperer, John D.

AU - Rosengart, Todd K.

AU - Gold, Jeffrey P.

AU - Peterson, Powers

AU - DeBois, William

AU - Altorki, Nasser K.

AU - Lang, Samuel

AU - Thomas, Stephen

AU - Isom, O. Wayne

AU - Krieger, Karl H.

PY - 1996/11

Y1 - 1996/11

N2 - Background. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. The benefit of the acute removal and reinfusion of fresh autologous blood around time of cardiopulmonary bypass-a technique known as intraoperative autologous donation (IAD)-has not been universally accepted. We sought to more clearly evaluate the effects of IAD on allogeneic transfusion and postoperative bleeding by removing, preserving, and reinfusing a calculated maximum volume of fresh autologous whole blood. Methods. Ninety patients undergoing coronary artery bypass grafting or valvular operations were prospectively randomized to either have (IAD group) or not have (control group) calculated maximum volume IAD performed. Treatment was otherwise identical. Transfusion guidelines were uniformly applied to all patients. Results. An average volume of 1,540 ± 302 mL of fresh autologous blood was removed and reinfused in the IAD group. Postoperative hematocrits were significantly greater at 12 and 24 hours postoperatively in the IAD group versus the control group despite a significant decrease in both the percentage of patients in whom allogeneic red blood cells were transfused (17% versus 52%; p < 0.01) and the number of red blood cell units transfused per patient per group (0.28 ± 0.66 and 1.14 ± 1.19 units; p < 0.01). Conversely, chest tube output, incidence of excessive postoperative bleeding, postoperative prothrombin time, and platelet and coagulation factor transfusion requirement did not differ between groups. Conclusions. These results indicate that intraoperative autologous donation serves to preserve red blood cell mass. Its routine use in eligible patients is therefore justified. However, the removal and reinfusion of an individually calculated maximum volume of fresh autologous blood had no effect on postoperative bleeding or platelet and coagulation factor transfusion requirement. This lack of hemostatic effect belies the beliefs of many about the primary action of IAD, helps to delineate the optimal way in which to perform IAD, and carries implications regarding the use of allogeneic platelet and coagulation factors for the treatment of early postoperative bleeding.

AB - Background. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. The benefit of the acute removal and reinfusion of fresh autologous blood around time of cardiopulmonary bypass-a technique known as intraoperative autologous donation (IAD)-has not been universally accepted. We sought to more clearly evaluate the effects of IAD on allogeneic transfusion and postoperative bleeding by removing, preserving, and reinfusing a calculated maximum volume of fresh autologous whole blood. Methods. Ninety patients undergoing coronary artery bypass grafting or valvular operations were prospectively randomized to either have (IAD group) or not have (control group) calculated maximum volume IAD performed. Treatment was otherwise identical. Transfusion guidelines were uniformly applied to all patients. Results. An average volume of 1,540 ± 302 mL of fresh autologous blood was removed and reinfused in the IAD group. Postoperative hematocrits were significantly greater at 12 and 24 hours postoperatively in the IAD group versus the control group despite a significant decrease in both the percentage of patients in whom allogeneic red blood cells were transfused (17% versus 52%; p < 0.01) and the number of red blood cell units transfused per patient per group (0.28 ± 0.66 and 1.14 ± 1.19 units; p < 0.01). Conversely, chest tube output, incidence of excessive postoperative bleeding, postoperative prothrombin time, and platelet and coagulation factor transfusion requirement did not differ between groups. Conclusions. These results indicate that intraoperative autologous donation serves to preserve red blood cell mass. Its routine use in eligible patients is therefore justified. However, the removal and reinfusion of an individually calculated maximum volume of fresh autologous blood had no effect on postoperative bleeding or platelet and coagulation factor transfusion requirement. This lack of hemostatic effect belies the beliefs of many about the primary action of IAD, helps to delineate the optimal way in which to perform IAD, and carries implications regarding the use of allogeneic platelet and coagulation factors for the treatment of early postoperative bleeding.

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