Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion
Editorial Group: Cochrane Injuries Group
Published Online: 14 APR 2010
Assessed as up-to-date: 31 JUL 2009
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 14 APR 2010
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.
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.
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.
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.
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.
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
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.
評估術前自體捐血(preoperative autologous blood donation (PAD))對於減少手術前後需要異體紅血球輸血的證據。
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。
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。
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。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。