Rikiya Abe

Autologous Blood Donation Elective Surgery in Children

Studies were made on 59 children (cardiac 42, orthopaedic 13, miscellaneous 4) scheduled for autologous blood donation before elective surgery. The donor‐patients ages ranged from 3 to 15 years (mean 9.9 years) and their weights from 13 to 70 kg (mean 34 kg). All patients received 50–100 mg of oral iron sulphate per day. As a rule, about 10% of intravascular blood volume was drawn once a week. Before surgery, an average of 720 ml of autologous blood per patient was prepared. Two patients failed to donate autologous blood because of anxiety about the procedure; however, none of the donors was deferred due anaemia assoicated with the phlebotomy. Of the 53 patients undergoing surgery and participating in autologous predonation, 50 (94%) were able to avoid homologous blood transfusion. 600 ml of homologous blood were transfused to each of 2 orthopaedic patients and 400 ml to 1 cardiac patient. We conclude that a predeposit autologous transfusion programme is logistically possible in small children when the patients are cooperative.

New “leap-frog” technique for autologous blood donation

In order to obtain a sufficient volume of autologous blood for elective surgery, we used a Sterile Connection Device (SCD, DuPont, Mass. U.S.A.) and a liquid storage method that is called the leap-frog. From 300 to 2800 mL (mean 1158 mL) of blood were collected from 126 patients during an average of six donations over 14-125 days (mean 33 days). 101 patients (80%) required no homologous blood during their surgery. No bacterial contamination was observed in the connected tubes. We submit that it is possible to obtain an adequate volume of blood with a simple technique using this method.

Autologous blood donation in patients with rheumatoid arthritis. In comparison with patients with iron deficiency anemia.

Autologous blood donation was conducted without using recombinant human erythropoietin (r-HuEPO) in 16 patients with rheumatiod arthritis. As a rule, 200 or 400ml of autologous blood was drawn once a week, if the hemoglobin (Hb) level before each donation was 11g/dl or more. The results were compared with that in 17 patients with iron deficiency anemia.It required an average of 4 weeks to yield 500ml of autologous blood per patient in both groups.The administration of iron sulphate rose the mean Hb levels in patients with iron deficiency anemia and made it possible to collect autologous blood. Ferritin (Ft) levels were within the normal range during the donation period, which implied an effective utilization of iron sulphate for erythropoiesis. Serum erythropoietin levels returned gradually to normal.On the other hand, in patients with rheumatoid arthritis appropriate endogenous erythropoietin response to phlebotomy-induced anemia was not observed even they received sufficient iron supplementation. The change in Ft levels suggested an increase in iron storage due to iron overdose. Thus, r-HuEPO administration may have the potential for the success of autologous blood donation in patients with rheumatoid arthritis.

Risk of transfusion-associated graft-versus-host disease as a result of directed donations from relatives.

Transfusion-associated graft-versus-host disease (TA-GVHD) was described as occurring after nonirradiated blood tranfusion not only in immunosuppressed but also in immunocompetent recipients who share one HLA haplotype with HLA-homozygous blood donors.From the distribution of 1% or more frequencies of HLA-A, -B, -C, -DR, -DQ haplotypes obtained at the 11th International Histocompatibility Workshop (1991), using the fomulae of Kanter, we tried to calculate the potential risk of TA-GVHD as a result of directed donations from relatives in the Japanese and other ethnic groups.The Japanese have the greatest risk of TA-GVHD than any other populations because are more homogeneous in HLA and have a common haplotype: A24-CBL-Bw52-DRw15-DQw1 (7.5%).Of noteworthing, the risk of transfusion of HLA-homozygotes to heterozygotes among 1st-degree relatives in the Japanese was 4.7-folds compared with that of transfusion in the U. S. A. population. And, the risk of TA-GVHD among the Japanese unrelated was near to that of transufusion among the French first degree relatives.Therefore, we recommend that donations of blood components from recipients relatives should be irradiated essentially, and as possible even from unrelated donors in the Japanese population.

Autologous blood transfusion in children.

Fifty children (26 girls and 24 boys) scheduled for autologous blood donation before elective surgery were studied. As a rule, about 10% of intravascular blood volume estimated by the Morse formula was drawn once a week. Before surgery, an average of 3.5 units of autologous blood per patient were prepared during the 25 days of donation period. Two patients excited at the thought of phlebotomy failed to donate autologous blood, but none of the autologous blood donors was deferred due to phlebotomy-induced anemia. Since an appropriate endogenous erythropoietin response was observed, which might stimulate erythropoiesis.The ages of the donor-patients ranged from 4 to 15 years with a mean of 9.8 years, and weighing from 15 to 70kg with a mean of 34kg. All patients received about 50mg of iron sulphate per day orally. Of the 48 patients who donated autologous blood, 48 underwent surgery without using homologous blood. Three units of homologous blood were transfused to each of 2 orthopedic patinets.We conclude that a predeposit autologous transfusion program in children can be performed safely when patients are cooperative.

Low incidence of post-transfusion hepatitis by screening for anti-hepatitis C virus antibody.

To see whether the introduction of screening for hepatitis C virus (HCV) would be worthwhile, the incidence of post-transfusion non-A, non-B hepatitis (PT-NANBH) was assessed among patients receiving blood during operation at Fukushima Medical College Hospital.230 patients before screening and 108 after screening, who received blood from an average of 6.7 donors and 5.3 donors, respectively, were followed up and evaluated. Remarkable reduction of the incidence of confirmed cases of PT-NANBH was observed. 20 (8.7%) of the patients before screening showed biochemical evidence of PT-NANBH, whereas only 3 (2.8%) cases after screening did. In contrast to confirmed cases, there was a little reduction rate of suspected PT-NANBH by the screening, 16.1% before and 12.0% after screening, respectively.These results suggest that mass-screening for anti-HCV is effective but still not perfect in reducing the PT-NANBH.Moreover, irradiating the blood positive for anti-HCV had no protective effect in the incidence of PT-NANBH in recipients.

The reduction of donor numbers by small volume red blood cell transfusion using sterilely connected satellite bags in neonatal patients.

For neonatal recipients, we supply routinely concentrated red cells (CRC) divided into 3 packs by using the Sterile Connection Divice (SCD, Dupon, USA). This study shows the effectiveness of the sterilely connected satellite bags in saving the number units (=donor number) transfused.The fact as follows were observed that most of CRC transfused were within 15-20ml in transfusion volume and the transfusion was repeated frequently in many neonatal patients. By the introduction of 3 packed-CRC, donor numbers exposed were reduced to 70% of the number before the introduction.