HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Luca Sandrelli Alessandro Pardini Roberto Lorusso Ottavio Alfieri Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sandrelli, L. Articles by Alfieri, O. Search for Related Content PubMed PubMed Citation Articles by Sandrelli, L. Articles by Alfieri, O.

Ann Thorac Surg 1995;59:730-735
© 1995 The Society of Thoracic Surgeons

Impact of Autologous Blood Predonation on a Comprehensive Blood Conservation Program

II Cardiac Surgery Department and Transfusion Service, Spedali Civili, Brescia, Italy

Accepted for publication December 8, 1994.

	Abstract

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 
Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use in cardiac operations. The aim of our study was to verify the effectiveness of this procedure and to see whether it is compatible with a comprehensive blood conservation program. Three hundred forty-eight patients (group 1) donated an average of 657 ± 199 mL of blood before open heart operation, whereas 344 patients (group 2) without autologous predonation were used as a control. The two groups were compared with regard to homologous blood use and the possibility of applying other blood conservation measures. Homologous transfusion rate in group 1 was 12.6%, whereas in group 2 it was 46% (p < 0.001). Patients with three units of predonated autologous blood had a transfusion rate of 0.8% (p < 0.001 compared with group 2). In group 1, acute normovolemic hemodilution was accomplished in a lower number of patients and with a lower average withdrawal (338 ± 102 versus 403 ± 145 mL; p < 0.001). Other blood conservation measures such as the return of mediastinal drainage and use of residual blood of extracorporeal circulation were applied with similar results in both groups. In our experience, preoperative autologous donation was compatible with the application of other blood conservation measures, but acute normovolemic hemodilution was achieved in a lower number of patients. Preoperative autologous donation proved to be a highly effective method for reducing banked blood use and therefore homologous blood exposure during and after cardiac operations.

	Introduction

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 
Despite enormous improvements in preventing transfusion-related diseases, homologous transfusion still represents a high-risk procedure due to transfusion reactions or transfusion-related diseases [1–4]. Many patients undergoing cardiac operations receive a homologous blood product during the time of their hospitalization and consequently are exposed to such risks as viral or bacterial infection and hemolytic reactions [2, 3]. For this reason, many cardiac surgeons seek to develop adequate systems to reduce transfusions during and after open heart operations.

During the last decades, many techniques have proved to be useful for this purpose [5]. Acute normovolemic hemodilution [6], acute preoperative plasmapheresis [7], reinfusion of shed mediastinal blood [8], and the use of pharmacologic agents such as aprotinin [9] or erythropoietin [10] all have been shown to be highly effective in reducing blood use during and after cardiac operations. Recent reports underline the efficacy of combining these techniques in a blood conservation program to further decrease blood use [11–13] and therefore also to decrease the risk of blood-related infections.

Preoperative autologous donation (PAD) has been considered an effective blood-saving method; several reports underline its efficacy in decreasing use of homologous blood products both in cardiac surgery and in other surgical disciplines [14–17].

In this report, we examine the impact of a PAD program in our clinical practice and look at whether or not this procedure is compatible with other blood conservation measures and, consequently, if it is to be considered in the setting of a comprehensive blood conservation program in cardiac surgery.

	Material and Methods

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 
We prospectively collected the data of 348 consecutive adult patients who between January 1992 and November 1993 had survived elective open heart operation and who entered the predonation program (21.7% of the patients operated on during the period of the study) (group 1). As a control, we prospectively selected 344 matched patients undergoing elective operations during the same period (Group 2). The inclusion criteria for group 2 patients included age, preoperative parameters and clinical status equivalent to group 1. They were not eligible to enter the predonation program for nonclinical reasons (eg, living in other regions, refusal to attend PAD). Preoperative hemoglobin values were not considered as exclusion criteria.

Predonation Program
Patients scheduled for elective operations were asked preoperatively to enter the predonation program. Inclusion criteria included hemoglobin values greater than 12 g/dL and an age limit of less than 70 years. Following Goodnough's guidelines [18], exclusion criteria were unstable angina or symptoms of disease on the day of donation, severe aortic stenosis with valve area less than 0.8 cm², congestive heart failure, left main coronary artery disease, congenital cyanotic heart disease, and hematologic diathesis. All patients were asked to give detailed information regarding modifications in their cardiac symptoms. Predonation and intradonation blood pressure and pulse rate were monitored. Each donation consisted of about 300 to 350 mL of blood (1 unit) and usually was completed within 15 minutes. All the autologous blood was collected in silicone bags containing CPDA 1 (citrate, phosphate, dextrose, adenosine). The predonation procedure was carried out from 30 to 7 days before the operation.

After the first unit of blood was taken, we considered whether to ask further predonations of up to three units per patient in case of hemoglobin values greater than 12 g/dL and of clinical stability. Once collected, the autologous blood was processed to obtain red blood cell (RBC) concentrates and fresh frozen plasma. In the absence of clinical contraindications, we suggested oral iron supplementation (325 mg three times daily) up to the operation date. No erythropoietin or intravenous iron therapy was considered in this patient population. All patients attending PAD were asked to sign informed consent before the first donation.

Blood Conservation Program
SURGICAL HEMOSTASIS AND CARDIOPULMONARY BYPASS.
Meticulous surgical hemostasis was considered the very first step in preventing postoperative blood loss. Before protamine administration, all surgical bleeding points were controlled and particular care was taken when internal thoracic arteries were used.

Clear priming of the cardiopulmonary bypass circuit was applied routinely, and global volume was reduced according to the patient's body mass and oxygenator performance to diminish systemic hemodilution. Cardiopulmonary bypass was carried out with membrane oxygenator in all patients.

AUTOTRANSFUSION PROTOCOL.
According to the preoperative conditions, patients were evaluated for the possibility of performing acute normovolemic hemodilution immediately after anesthesia induction. Exclusion criteria were hemodynamic instability after induction or hematocrit values less than 36%. In eligible patients, one or two units (300 and 600 mL, respectively) of whole blood was collected, stored at room temperature, and reinfused after heparin protamine reversal.

At the end of extracorporeal circulation, blood residual of the pump was processed by a cell separator to obtain washed red blood cell concentrate, which was reinfused routinely to increase hematocrit value.

Shed mediastinal reinfusion was accomplished within 6 hours after operation in case of substantial bleeding (ie, more than 100 mL/h).

APROTININ.
Low dose aprotinin (2 million KIU) was added to the priming of the cardiopulmonary bypass machine in patients with a high risk of intraoperative and postoperative bleeding, namely those undergoing a second or third cardiac operation, those who had not stopped receiving antiplatelets agents at least 2 weeks before the operation, and patients affected by endocarditis.

Transfusion Guidelines
General transfusion guidelines [18] were followed during and after operation for both groups. Red blood cell concentrates were used to increase hematocrit values on an individual basis for each patient according to his or her clinical condition and type of operation. We allowed hemodilution to a hematocrit of 18% on cardiopulmonary bypass while hemoglobin values less than 8 g/dL was considered a general threshold for transfusion of RBC in the postoperative period. Fresh frozen plasma was used to correct hemostatic unbalance with altered coagulation tests (prothrombin time ratio greater than or equal to 1.5 times control or partial thromboplastin time greater than 40 seconds or both) after extracorporeal circulation. Platelet concentrates were transfused in case of bleeding with concomitant severe thrombocytopenia (platelet count less than 100,000 µL).

Considering the risks related even to autologous blood transfusion (infection, human error), we did not freely give back to group 1 patients their own blood, but used autologous units with similar transfusion threshold with respect to group 2. In addition, we did not practice autologous ``cross-over'' [19], and as a consequence, we assumed that unused autologous blood was not to be made available to other patients.

Statistical Analysis
Differences between the two groups were analyzed by means of two-tailed Student's t test for continuous variables and ² analysis for categoric variables. Values are presented as mean ± standard deviation of the mean. A stepwise multivariate logistic regression analysis was used to determine the key predictors of the need for homologous blood. Variables included in the analysis are listed in Appendix 1. Differences were considered to be significant at p values of less than 0.05.

	Results

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 
Patient characteristics are shown in Table 1. There were no significant differences in factors determining application of blood-saving measures and postoperative blood loss. The two groups were comparable as to age, sex, type of operation, number of reoperations, extracorporeal circulation time, aortic cross-clamp time, and number of internal thoracic arteries used. Among the 348 patients who entered the predonation program, 49 had one unit, 184 had two units, and 115 had three units of autologous blood withdrawn, respectively. The mean amount of blood predonated per patient was 657 ± 199 mL. Most of the patients (n = 203; 87%) with only one or two units of predonated blood had to abandon their program because of low hemoglobin values. Other factors determining termination included the beginning of donation too close to the operation and poor venous access. Four patients (1.1%) with coronary artery disease suffered mild angina after donation, with no electrocardiographic signs of ischemia, and required 1 day of observation in the hospital. Nevertheless, these patients were operated on normally as scheduled. The average admission hemoglobin value was 13.0% ± 1.2% in group 1, whereas in group 2 it was 13.6% ± 1.6% (p < 0.001). Platelet count was also significantly lower at admission in group 1 patients, with an average of 225 ± 65 versus 248 ± 63 x 10³/mL (p = 0.004).

View larger version (17K): [in this window] [in a new window]   Fig 1. . Transfusion rate of control group compared with group 1 patients distributed according to the number of units of autologous blood available. (AP = autologous predonation; *p < 0.001.)

View larger version (25K): [in this window] [in a new window]   Fig 2. . Frequency distribution of homologous red blood cell concentrate transfusions.

	Comment

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 
Risks related to donated homologous blood transfusions are still high in terms of viral infections and transfusion reactions [1–4]. On the other hand, self-donated blood diminishes these risks [14–17]. Transfusion needs in cardiac operations have dramatically declined over the last three decades but still a high number of patients are exposed to allogenic blood during and after open heart operations [2, 3]. In addition, postoperative administration of blood might change risk parameters and patient outcome, particularly in the elderly [20]. Because of the high risks related to homologous transfusions, application of a comprehensive blood-saving program is a daily concern in open heart surgery, which aims at reducing homologous blood use. Among blood-sparing measures, autotransfusion has been judged as the safest form of transfusion therapy. Although Ward and associates [21] recently have given some word of caution about the effectiveness of retransfusion of shed mediastinal blood in reducing blood use in cardiac operations, several methods of autotransfusion have been confirmed as highly effective in reducing blood loss and blood use after open heart operations [13, 14, 16, 22]. Furthermore, recent reports underline the importance of combining these procedures to increase the capability of a single measure [11].

Autologous blood predonation has been pointed out as safe and effective in avoiding or decreasing homologous blood product transfusions during and after cardiac operations even in patients once considered not eligible for this procedure [16, 22]. The present study was designed to verify the real clinical impact of a blood predonation program and to see whether PAD was safe and effective in sparing homologous blood products and was compatible with other blood-saving measures. The only difference between the two groups compared in this study was the availability of predonated autologous blood; the other blood-saving measures were used according to the preestablished norms.

Group 1 patients were admitted for operation with a significantly lower hemoglobin value. This is of course related to preoperative blood collection and, as a consequence, group 1 patients had lower application of acute normovolemic hemodilution both in the number of patients and in the average donation per patient. Platelet count was lower in group 1 as well. Nevertheless, bleeding after operation was similar in both groups even in the first hours after operation, proving that autologous predonation does not produce hemostatic unbalance and can compensate and be even better than acute normovolemic hemodilution. Other blood-saving techniques such as reinfusion of shed mediastinal blood and of the residual of extracorporeal circulation were accomplished in both groups in a similar manner. On this view, predonation is compatible with and does not exclude the application of other techniques designed for allogenic exposure reduction except for acute normovolemic hemodilution, which was applicable in a lower number of patients from whom on the average was withdrawn a lower quantity of blood.

Patients with autologous predonation had a marked average reduction of banked blood use. Better results were obtained in patients with three available units, in whom the risks of transfusion exposure were nearly zero, whereas patients with only 1 unit showed no difference in terms of homologous blood exposure when compared with the nondonor population.

Owings and colleagues [15] showed that good results in terms of global and homologous transfusion were obtained in patients by whom three units of autologous blood were predonated. Our experience confirms that donation of three units prevents excessive hemodilution and is nearly always sufficient to cover blood needs after an open heart operation. Patients with two available units have a relative decrease in transfusion rate as well, but not equal to those with three units. Patients with only one autologous unit available had no differences in terms of allogenic blood exposure when compared with the control population. This must be taken into account in programming donation stages because too short a time available for the withdrawal is one of the main reasons for deferral. We think that starting with the first donation at least 3 weeks before operation could allow a greater number of patients to complete the program.

Although oral iron therapy was suggested during the course of predonation, most of the deferrals were due to low hemoglobin values. We did not speculate on this problem, but probably a more aggressive iron therapy in selected patients could be considered. In any case, the time available for oral iron therapy during the course of predonation seems to be too short to change anemic patterns and to increase hemoglobin values significantly [23].

Taking into consideration the frequency distribution of RBC concentrate transfusions, we found that the great majority of the transfused patients in group 2 received one to three units of homologous blood. This is a strong suggestion that those patients could have avoided any contact with donor blood if they had entered and completed the predonation program.

In our present study, the patient population is quite heterogeneous to reflect the entire spectrum of daily cardiac surgical procedures. In this heterogeneous population, the principal determinants of postoperative blood requirements were total blood loss, advanced age, and the absence of autologous predonated blood. Excluding this last variable, the others were equal in both groups, thereby demonstrating the groups' comparability. Other well-known factors determining blood consumption such as advanced cardiac disease and urgent/emergency operation were not included in the variable list because they were exclusion criteria for total patient enrollment.

From our experience, autologous predonation has proved to be a safe procedure. Among the patients enrolled in the program, only 4 had mild angina symptoms without clinical relevance immediately after donation and underwent coronary artery operation as scheduled. Selection of the patients seems to be crucial for preventing complications. Strict observation of the inclusion criteria avoided a higher complication rate.

Birkmeyer and associates [24] stated that cost-effectiveness of PAD must be reconsidered. However, as a result of our experience, we can affirm that PAD, with very low adjunctive costs to the total price of a cardiac operation, can almost completely avoid the use of banked blood and, as a consequence, reduce the need for donors.

A number of limitations of this study should be considered. This is a nonrandomized study in which subjective consideration led to the donation of autologous blood. Nevertheless, the aim of our study was not only to verify the effectiveness of PAD, which already has been established, but rather to verify the clinical impact of this technique on a daily surgical practice and its compatibility with other blood conservation measures.

The study design was limited by the fact that blinding for the availability of autologous blood was not possible. Nevertheless, the same transfusion criteria were followed for both groups, resulting in comparability for decision-making for transfusion.

Oral iron therapy was suggested but actually few patients made use of it. A randomized study involving the use of iron therapy during the donation period is now being carried out in our institute to see whether there is a significant difference in the amount of blood donated.

In conclusion, our results suggest that wide application of a preoperative donation program could markedly decrease the use of banked blood in cardiac operations with very low procedural risks and that this procedure is compatible with other blood-saving measures with the result of further decreasing the need for allogenic blood products. The initiation of a predonation program as part of a comprehensive blood conservation program resulted in a drastic decrease in our use of homologous blood.

	Appendix 1. Variables Included in Multivariate Analysis

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 
Preoperative variables

Age

Sex

Body surface area

ABO group

Preoperative hemoglobin level

Preoperative platelet count

Left ventricular ejection fraction

Prior cardiac surgical procedure

Autologous predonation

Operative variables

Extracorporeal circulation time

Aortic cross-clamp time

Type of operation

Coronary artery bypass grafting

Valve repair/replacement

Combined valve and coronary artery operation

Atrial septal defect

Number of distal anastomoses

Use of internal thoracic arteries

Use of acute normovolemic hemodilution

Use of aprotinin

Postoperative variables

Blood loss at 6 and 24 hours

Total blood loss

Reinfusion of blood residual of the pump

Use of shed mediastinal reinfusion

24-hour postoperative hemoglobin values

Hospital discharge hemoglobin values

Hospital discharge platelet count

Postoperative blood products transfusion

Red blood cell concentrate

Fresh frozen plasma

Platelet concentrate

	Footnotes

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 
Address reprint requests to Dr Sandrelli, II Cardiochirurgia, Spedali Civili, P.le Spedali Civili, 1, 25125 Brescia, Italy.

	References

Top Footnotes Abstract Introduction Material and Methods Results Comment Appendix 1. Variables Included... References

 

1. Carson JL, Russell LB, Taragin MI, Sonnenberg FA, Duff AE, Bauer S. The risk of blood transfusion: the relative influence of acquired immunodeficiency syndrome and non A-non B hepatitis. Am J Med 1992;92:45–62.[Medline]
2. Aach RD, Kahn RA. Post-transfusion hepatitis: current perspectives. Ann Intern Med 1980;92:539–46.
3. Sazama K. Report of 355 transfusion-associated deaths: 1976 through 1985. Transfusion 1990;30:583–90.[Medline]
4. Van Der Poel CL, Reesink HW, Schoosbert W, et al. Infectivity of blood seropositive for hepatitis C virus antibodies. Lancet 1990;335:558–60.[Medline]
5. Dietrich W, Baramkay A, Dilthey G, Mitto HP, Richter JA. Reduction of blood utilization during myocardial revascularization. J Thorac Cardiovasc Surg 1989;97:213–9.[Abstract]
6. Boldt J, Kling D, Weidler B, et al. Acute preoperative hemodilution in cardiac surgery: volume replacement with a hypertonic saline-hydroxyetyl starch solution. J Cardiothorac Vasc Anesth 1991;5:23–8.[Medline]
7. Boldt J, Kling D, Zickmann B, Jacobi M, Dapper F, Hempelmann G. Acute preoperative plasmapheresis and established blood conservation techniques. Ann Thorac Surg 1990;50:62–8.[Abstract]
8. Eng J, Kay PH, Murday AJ, et al. Postoperative autologous transfusion in cardiac surgery. A prospective, randomized study. Eur J Cardiothorac Surg 1990;4:595–600.[Abstract]
9. Bidstrup BP, Royston D, Sapsford RN, Taylor KM. Reduction of blood loss and blood use after cardiopulmonary bypass with high dose aprotinin. J Thorac Cardiovasc Surg 1989;97:364–72.[Abstract]
10. Watanabe Y, Fuse K, Konoshi T, et al. Autologous blood transfusion with recombinant human erythropoietin in heart operation. Ann Thorac Surg 1991;51:767–72.[Abstract]
11. Jones JW, Rawitscher RE, McLean TR, Beall AC, Thornby J. Benefit from combining blood conservation measures in cardiac operations. Ann Thorac Surg 1991;51:541–6.[Abstract]
12. Scott WJ, Rode R, Castelmain B, et al. Efficacy, complications, and cost of a comprehensive blood conservation program for cardiac operations. J Thorac Cardiovasc Surg 1992;103:1001–7.[Abstract]
13. Øvrum E, Åm Holen E, Lindstein-Ringdal MA. Coronary artery bypass surgery with minimal use of homologous blood. Effects of a simple and inexpensive blood conservation program. Eur J Cardiothorac Surg 1990;4:644–8.[Abstract]
14. Britton LW, Eastlund DT, Dziuban SW, et al. Predonated autologous blood use in elective cardiac surgery. Ann Thorac Surg 1989;47:529–32.[Abstract]
15. Owings DV, Kruskall MS, Thurer RL, Donovan LM. Autologous blood donations prior to elective cardiac surgery. Safety and effect on subsequent blood use. JAMA 1989;262:1963–8.[Abstract/Free Full Text]
16. Dzik WH, Fleisher AG, Ciavarella D, Karlson KJ, Reed GE, Berger RL. Safety and efficacy of autologous blood donation before elective aortic valve operation. Ann Thorac Surg 1992;54:1177–81.[Abstract]
17. Rebulla P, Giovanetti AM, Mercuriali F, Sirchia G. Autologous predeposit for elective surgery: an Italian experience. World J Surg 1987;11:47–52.[Medline]
18. Goodnough LT, Johnston MFM, Ramsey G, et al. Guidelines for transfusion support in patients undergoing coronary artery bypass grafting. Ann Thorac Surg 1990;50:675–83.[Abstract]
19. Schönberger JPAM, Bredèe JJ, Tijan D, Everts PAM, Wildevuur CRH. Intraoperative predonation contributes to blood saving. Ann Thorac Surg 1993;56:893–8.[Abstract]
20. Pifarré R. Open heart operations in the elderly: changing risk parameters. Ann Thorac Surg 1993;56:S71–3.
21. Ward HB, Smith RRA, Landis KP, Nemzek TG, Dalmasso AP, Swain WR. Prospective, randomized trial of autotransfusion after routine cardiac surgery. Ann Thorac Surg 1993;56:137–41.[Abstract]
22. Silverglaid AJ. Safety and effectiveness of predeposit autologous transfusions in preteen and adolescent children. JAMA 1987;257:3403–4.[Abstract/Free Full Text]
23. Bridgen ML. Iron deficiency anemia. Every case is instructive. Postgrad Med 1993;93:185–92.
24. Birkmeyer JD, AuBuchon JP, Littemberg B, et al. Cost-effectiveness of preoperative autologous donation in coronary artery bypass grafting. Ann Thorac Surg 1994;57:161–9.[Abstract]

This article has been cited by other articles:

				N. Hibino, M. Nagashima, H. Sato, T. Hori, H. Ishitoya, and T. Tomino Preoperative Autologous Blood Donation for Cardiac Surgery in Children Asian Cardiovasc Thorac Ann, February 1, 2008; 16(1): 21 - 24. [Abstract] [Full Text] [PDF]

				L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom Transfusion Therapy and Blood Conservation Card. Surg. Adult, January 1, 2008; 3(2008): 415 - 430. [Full Text]

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

				L. Y. Lee, W. J. DeBois, K. H. Krieger, and O. W. Isom Transfusion Therapy and Blood Conservation Card. Surg. Adult, January 1, 2003; 2(2003): 389 - 400. [Full Text]

				Y. J. Woo and T. J. Gardner Myocardial Revascularization with Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2003; 2(2003): 581 - 607. [Full Text]

				K. Shibata, S. Takamoto, Y. Kotsuka, and H. Sato Effectiveness of combined blood conservation measures in thoracic aortic operations with deep hypothermic circulatory arrest Ann. Thorac. Surg., March 1, 2002; 73(3): 739 - 743. [Abstract] [Full Text] [PDF]

				H. Masuda, Y. Moriyama, K. Hisatomi, R. Toda, S. Shimokawa, Y. Iguro, S.-i. Watanabe, H. Matsumoto, and A. Taira Preoperative autologous donation of blood for a simple cardiac anomaly: Analysis of children weighing under twenty kilograms J. Thorac. Cardiovasc. Surg., October 1, 2000; 120(4): 783 - 788. [Abstract] [Full Text] [PDF]

				M. A. Forgie, P. S. Wells, A. Laupacis, D. Fergusson, and for the International Study of Perioperative Trans Preoperative Autologous Donation Decreases Allogeneic Transfusion but Increases Exposure to All Red Blood Cell Transfusion: Results of a Meta-analysis Arch Intern Med, March 23, 1998; 158(6): 610 - 616. [Abstract] [Full Text] [PDF]

				K. Fukahara, A. Murakami, T. Ueda, Y. Doki, S. Tsubata, F. Ichida, and T. Misaki SCHEDULED AUTOLOGOUS BLOOD DONATION AT THE TIME OF CARDIAC CATHETERIZATION IN INFANTS AND CHILDREN J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 504 - 505. [Full Text]

				J. A. Magovern, T. Sakert, D. H. Benckart, J. A. Burkholder, G. A. Liebler, G. J. Magovern Sr, and G. J. Magovern Jr A Model for Predicting Transfusion After Coronary Artery Bypass Grafting Ann. Thorac. Surg., January 1, 1996; 61(1): 27 - 32. [Abstract] [Full Text]

This Article Abstract Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Luca Sandrelli Alessandro Pardini Roberto Lorusso Ottavio Alfieri Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sandrelli, L. Articles by Alfieri, O. Search for Related Content PubMed PubMed Citation Articles by Sandrelli, L. Articles by Alfieri, O.