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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2007 March;73(3):153-60
Preoperative autologous blood donation - Part II.
Adapting the predeposit- concept to the physiological basics of erythropoiesis improves its efficacy
Singbartl G. 1, Malgorzata S. 2, Quoss A. 2
1 Department of Anesthesiology, Intensive Care and Transfusion Medicine, ENDO-Klinik Hamburg GmbH, Hamburg, Germany;
2 Department of Anesthesiology, Rheumaklinik Bad Bramstedt, Bad Bramstedt, Germany
Aim. Only two clinical parameters have been demonstrated to be of decisive impact on efficacy [i.e. increase in red blood cell (RBC)]-mass] of the autologous predeposit; the time interval between predeposit and elective surgery that correlates positively with increase in RBC-mass, and the haematocrit-level at predeposit that correlates negatively with it. These two determinants of efficacy might be applied most efficaciously by combining them within one predeposit-session.
Methods. Prospective study concerning the efficacy of two different autologous predeposit-concepts in osteoarthritis (n=160) and rheumatoid arthritis patients (n=74); the conventional “two separately collected units concept” (one RBC-unit each on two separate predeposit-sessions) and the new “one double deposit” concept (two RBC-units on one predeposit-session). The increase in RBC-mass was calculated with the haematocrit-method. Statistical analysis by ANOVA with post-hoc-test to Scheffé/H-test, and U-test; P<0.05 with Bonferroni-correction when appropriate.
Results. In either group of patients, increase in RBC-mass was higher with the new than the conventional predeposit concept (osteoarthritis: 261±114 vs 168±133 mL; P<0.000; rheumatoid arthritis: 239±112 vs 149±152 mL; P=0.039). Efficacy of either concept between osteoarthritis and rheumatoid arthritis patients was not different (new concept: 261±114 vs 238±112; P=0.765; conventional concept: 168±133 vs 149±152; P=0.941).
Conclusion. An autologous predeposit-concept considering the physiological basics of erythropoiesis (i.e. long time-interval between predeposit and elective surgery for RBC-regeneration, and a low haematocrit-level at/after autologous predeposit in order to stimulate erythrpoiesis) enhances RBC-recovery in a clinically relevant extent both in osteoarthritis and rheumatoid arthritis patients. Concerning efficacy of autologous predeposit, no differences were demonstrated between osteoarthritis and rheumatoid arthritis patients.