Re-inventing the wheel: the use of autologous and fresh donor blood in cardiac surgery

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Abstract
From the opening of a new cardiac surgical programme in November 1992, autologous and fresh donor blood (FDB) were used rather than cold stored blood (CSB) wherever possible in patients undergoing operations involving the use of cardiopulmonary bypass (CPB). In the first 250 consecutive patients, autologous blood was used in 168 (67.2%), fresh blood was used in 188 (75.2%). A total of 740 units of fresh blood were obtained on the day of operation (mean 3.9 ± 1.6 units per patient able to supply donors; 4.9 ± 1.7 units in the 147 who received fresh blood) and 728 units of stored blood were used (mean 3.08 ± 1.84 units per patient where fresh blood was used; 6.2 ± 2.5 units in the 114 where no fresh blood was used). The use of autologous blood significantly reduced FDB and CSB requirements (p < 0.001), was associated with a shorter intensive care and total postoperative stay (p = 0.006 and p = 0.033 respectively), even though there were more urgent and emergency cases in this group (p = 0.009) and no significant difference in chest drainage. Coagulopathy developed in 41 patients (16.4%) and was significantly associated with bypass time (p = 0.0001) and preoperative renal dysfunction (p = 0.005), although not with advanced age, sex, redo operation, diabetes or glucose-6-phosphate dehydrogenase deficiency. Patients with coagulopathy had significantly more transfused blood and blood products (p = 0.0001) and longer intensive care and total postoperative stays (p = 0.0001). In terms of blood conservation, the use of autologous blood was of primary importance. Correction of renal dysfunction and keeping overall bypass time to a minimum reduced the incidence of coagulopathy and, therefore, blood use. The use of FDB in this series was not clearly associated with improved overall results, but did generate more blood than was actually used, a factor of extreme importance in situations where stored blood is always in short supply.