Intervention Review

Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion

  1. David A Henry1,*,
  2. Paul A Carless2,
  3. Annette J Moxey3,
  4. Dianne O'Connell4,
  5. Katharine Ker5,
  6. Dean A Fergusson6

Editorial Group: Cochrane Injuries Group

Published Online: 14 APR 2010

Assessed as up-to-date: 31 JUL 2009

DOI: 10.1002/14651858.CD003602

Database Title

Additional Information

How to Cite

Henry DA, Carless PA, Moxey AJ, O'Connell D, Ker K, Fergusson DA. Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003602. DOI: 10.1002/14651858.CD003602.

Author Information

  1. 1

    Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada

  2. 2

    Faculty of Health, University of Newcastle, Discipline of Clinical Pharmacology, Newcastle, New South Wales, Australia

  3. 3

    Faculty of Health, University of Newcastle, Research Centre for Gender, Health & Ageing, Newcastle, New South Wales, Australia

  4. 4

    Cancer Council, Cancer Epidemiology Research Unit, Sydney, NSW, Australia

  5. 5

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

  6. 6

    University of Ottawa Centre for Transfusion Research, Ottawa Health Research Institute, Ottawa, Ontario, Canada

*David A Henry, Institute of Clinical Evaluative Sciences, 2075 Bayview Avenue, G1 06, Toronto, Ontario, M4N 3M5, Canada. david.henry@ices.on.ca.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 14 APR 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Public concerns regarding the safety of transfused blood have prompted reconsideration of the indications for the transfusion of allogeneic red cells (blood from an unrelated donor), and a range of techniques designed to minimise transfusion requirements.

Objectives

To examine the evidence for the efficacy of pre-operative autologous blood donation (PAD) in reducing the need for perioperative allogeneic red blood cell (RBC) transfusion.

Search methods

Articles were identified by searches of the electronic databases; MEDLINE (January 1950 to July 2009), EMBASE (January 1980 to Week 31, 2009), ISI Web of Science (inception to August 2009), The Cochrane Library 2009, Issue 3, and The Cochrane Injuries Group Specialised Register (searched August 7 2009). Reference lists in relevant publications were checked and authors were contacted to identify additional studies. The searches were updated in August 2009.

Selection criteria

Randomised controlled trials with a concurrent control group in which adult patients, scheduled for non-urgent surgery, were randomised to PAD, or to a control group who did not receive the intervention.

Data collection and analysis

Data were independently extracted and the risk of bias was assessed. Relative risks (RR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random-effects model. The principal outcomes were the proportion of patients exposed to allogeneic red blood cells (RBCs) and the amount of blood transfused. Other clinical outcomes are detailed in the review.

Main results

Fourteen trials were included. Overall PAD reduced the risk of receiving an allogeneic blood transfusion by a relative 68% (RR 0.32; 95% CI 0.22 to 0.47). The absolute reduction in risk of allogeneic transfusion was 44% (risk difference (RD) -0.44; 95% CI -0.68 to -0.21). In contrast, the results show that the risk of receiving any blood transfusion (allogeneic and/or autologous) is increased by PAD (RR 1.24; 95% CI 1.02 to 1.51). There was evidence of significant heterogeneity for both of these outcomes.

Authors' conclusions

Although the trials of PAD showed a reduction in the need for allogeneic blood, the methodological quality of the trials was poor and the overall transfusion rates (allogeneic and/or autologous) in these trials were high, and were increased by recruitment into the PAD arms of the trials. This raises questions about the true benefit of PAD. In the absence of large, high quality trials using clinical endpoints, it is not possible to say whether the benefits of PAD outweigh the harms.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Not certain that people are better off giving their own blood before surgery in case they need transfusion, when there is a safe blood bank

Although in developed countries the safety of blood supplies is high, there is still concern about contracting illness from transfusion. People often give their own blood before surgery for use if transfusion is needed (autologous donation). However, the review of trials found that it is not certain that people benefit. While pre-operative donation may reduce the chances of needing someone else's blood, it increases the chances of transfusion overall. It may be that donation causes some anaemia (low red blood cells), or surgeons are more likely to transfuse if autologous blood is available. Over-transfusion has risks, especially for older people.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

術前自體捐血以減少手術前後之異體輸血

大眾關心輸血的安全性，這促使有重新考慮異體紅血球輸血(血液來自不相關的捐贈者)的跡象，並設計一系列的技術以減少輸血需要。

目標

評估術前自體捐血(preoperative autologous blood donation (PAD))對於減少手術前後需要異體紅血球輸血的證據。

搜尋策略

經由下列電子資料庫檢索文章；MEDLINE (1950年1月至2009年7月)，EMBASE (1980年1月至2009年第31週)，ISI Web of Science (至2009年8月)，考科藍圖書館2009年第3期，及The Cochrane Injuries Group Specialised Register (2009年8月7日檢索)。檢查相關文獻的參考文獻表並連絡專家以找出更多的研究。2009年8月更新檢索的結果。

選擇標準

有並行對照組的隨機對照試驗，其中預定非緊急手術的成人病患被隨機分配到PAD，或不接受介入措施的對照組。

資料收集與分析

分別摘錄資料並評估偏差風險。計算Relative risks (RR)與 mean differences (MD)及其95% confidence intervals (CIs)。採用隨機效果模式來加總資料。主要的結果為病患接受異體紅血球(RBCs)的人數及輸血量。其他的臨床結果詳細說明於回顧的本文中。

主要結論

納入14篇試驗。整體來說PAD相對減少了68%接受異體輸血的風險(RR為0.32；95% CI為0.22至0.47)。以及絕對減少了44%異體輸血的風險(risk difference (RD)為−0.44；95% CI為−0.68至−0.21)。相反的，有結果顯示PAD會增加接受任何輸血(異體及/或自體)的風險(RR為1.24；95% CI為1.02至1.51)。有證據顯示這些結果有顯著的異質性。

作者結論

雖然PAD的試驗顯示PAD會減少異體輸血的需要，但試驗的方法學品質不佳且這些試驗整體的輸血率(異體及/或自體)偏高，且招募病患至PAD組本身即會提高輸血率。這出現了有關PAD真實效果的問題。在缺少大量，使用臨床評估指標之高品質的試驗下，無法說明是否PAD的效益大於傷害。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在有一個安全血庫的條件下，民眾在術前捐贈他們自己的血液以備不時之需也未必是上策。雖然已開發國家血液供給的安全性很高，但仍然要考量因為輸血而感染疾病。如果需要輸血，民眾通常會在術前捐贈他們自己的血液(自體捐贈)。然而，試驗的回顧發現，無法確定PAD對民眾有利。術前捐贈也許可以減少需要某人血液輸血的機會，但整體來說會增加輸血的機會。這也許是因為捐贈會導致一些貧血(低紅血球)，或在自體血液可取得的情形下外科醫師較有可能進行輸血。過度輸血有風險，尤其是老年人。

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