Limitations to donating adequate autologous blood prior to elective orthopedic surgery
L. T. Goodnough, J. Wasman, K. Corlucci and A. Chernosky
Department of Medicine, Case Western Reserve University, Cleveland, OH.
We reviewed 175 patients who predeposited autologous blood prior to
elective orthopedic surgery to define potential limitations of procuring
adequate autologous blood. These potential limitations include physician
underordering, storage interval, and erythropoietic response. We found that
a continuing medical education intervention increased the amount of
autologous blood requested by physicians for storage: from 121 U for 50
patients (mean = 2.4) before CME to 195 U for 65 patients (mean = 3.0)
afterward; eight (16%) of 50 patients had 4 U or more requested before CME
vs 25 (38%) of 65 patients afterward. Continuing medical education had no
impact on mean (+/- SD) effective storage interval, 22.6 +/- 9.0 vs 21.6
+/- 9.4 days. Thirty (17%) of 175 patients were deferred (hematocrit less
than or equal to 0.34) and were unable to donate units of blood requested;
of these, 13 (43%) received homologous blood compared with 19 (13%) of 145
not deferred. We conclude that a significant percentage of patients are
deferred from autologous donation because of hematocrit limitations and
receive homologous blood. This problem is not related to physician
underordering or inappropriate physician transfusion behavior, but rather
to the erythropoietic response to serial phlebotomy over a limited storage
interval. Future studies should focus on mechanisms to maximize autologous
blood procurement.
