Randomized Controlled Study Of Surgical Patients Undergoing Elective Surgery Of Preoperative Autologous Blood Donation

The current blood supply has been expanded to "national nervous" fromthe "seasonal tension" or "regional tensions". Although blood collectiondetection technology is relatively advanced, and transfusion-related diseasesgreatly reduced compared to the past,We still can not avoid the risk oftransfusion-related diseases. Autologous blood is a kind of transfusiontechnology.Firstly, the patient’s own whole blood donation or blood componentsdonation is collected, then properly stored、processed and then transfused, tomeet an emergency which needs blood transfusion or elective surgery. ABincludes the following three means: preoperative autologous blooddonation(PABD), blood salvage(BS) and acute hemodilution(AH).preoperative autologous blood donation is an attractive way to obtainautologous blood,thus it is easy to perform,relatively economical and safe inthe most of patients scheduled for elective surgery.And if it is used correctly,ithas been demonstrated to reduce significantly the use of allogeneic blood.PABD is the kind of transfusion technology which whole blood donation orblood components donation is Segmented autologous to save before the numberof days or several days ahead of surgery, then transfused when theimplementation of elective surgery, or during surgery, or after surgery. The late1980s, PABD had started to apply in foreign countries already. At that timescreening techniques is poor, such as AIDS and hepatitis B virus, then PABD was used to prevent the spread of AIDS.In1992, PABD reached a peak of itsdevelopment, and its blood donation rate was8.5%and blood transfusion ratewas5.0%. With the improvement of blood screening technology, the trend ofPABD applied is downward. In2001,its blood donation rate was4.0%andblood transfusion rate was2.6%.At this time, PABD has been mainly used tothese patients who bothered with antibodies of multiple transfusions andpatients with rare blood group. According to reports, PABD was used inapproximately60%elective surgery in Australia, even80%-90%in Japan, andit was formulated that PABD was used in80%-90%elective surgery. Now, insome developed cities of China, the application and research of PABD isgradually deepening, and even policy was supported by government in somecities. For example,《management approach of Beijing citizens blood donation》describes, tertiary hospitals AB rate should reach20%of the clinical bloodtransfusion rate. Furthermore,《Tertiary hospitals accreditation standardsimplementation details of Ministry of Health》4.19.34describes, Medicalinstitutions should actively carry out blood conservation technologies, andestablish their own management system of AB, PABD protection technology.The Class B requires the rate of AB reach25%of the clinical blood transfusionrate; and the Class A requires the rate of AB reach35%of the clinical bloodtransfusion rate. The current blood supply has been expanded to "nationalnervous" phenomenon. The study was designed to investigate PABD affectingthe blood system, the cost of blood transfusions, and the number ofpostoperative infection, the prognosis, the average length of hospital stay. Objective: To assess surgical patients undergoing elective surgery PABDclinical efficacy and practicality. In this study Objectively, to develop ascientific and rational PABD embodiment for the treatment of clinicaltransfusion provide scientific guidance, effectively saving blood resources, toreduce clinical transfusion-transmitted diseases,we use a randomized controlledmethods in this study. Methods: We select these surgical elective surgerypatients who met the inclusion/exclusion criteria and voluntarily signedinformed consent PABD200patients for the study, then use a randomizedcontrol method. Be PABD fitness assessments, based on the assessment level,stratified random allocation method, randomly assigned to the experimentalgroup and a control group of100patients in each group, these patientsundergoing PABD in experimental group, and the others transfuse allogeneicblood. Observe the test group and a control group of patients before and aftersurgery hematological parameters (red blood cell count RBC, white blood cellcount WBC, platelet count PLT, hemoglobin HGB, hematocrit Hct)、hospitalization time (compare the two groups of average hospital stay), adversereactions (two proportions and severity of adverse reactions), cost-effectiveness,prognosis and postoperative infection of the patients. Calculated data wereexpressed as mean±standard deviation （x±s） indicates, statistical analysisapply t test. Statistical analysis used software SPSS16.0. ImprovedQuality-Adjusted Life Year (IQALY) was used to analysis other data. To assessthe clinical efficacy and practicality of PABD,and to provide scientific,reliable and effective basis for clinical transfusion therapy.Results: Hematologicalindicators of patients show that the two groups had no significant difference inblood before donate blood, and that was not statistically significant.Hematological indicators of the two groups significant difference aftertransfusion. RBC, HGB and Hct in the experimental group is higher（p>0.05）than the control group, the WBC is relatively lower（p>0.05）, and the PLT isno significant difference（sp>0.05）.The experimental group is less average daysof hospitalization (15.5d versus23.5d), fewer adverse reactions(middle adversereactions3patients versus7patients; slight adverse reactions3patients versus10patients), less post-operative infections(2patients versus10patients), theprognosis is better(condition improved2patients versus6patients; not cured4patients in control group), with a slight local of donate blood reaction. Wedefine the less number is the better condition in IQALY. The value shows:IQALYexperimental=16.67；IQALYcontrol=34.The transfusion cost per patient in theexperimental group is less than the control group,￥1470per patient, in total￥141120. per patient saved500mL of blood, in total48000mL. Conclusion:Patients undergoing PABD which accelerated erythropoiesis, and the indicatorsof patients is even above the baseline. Thus In the physical condition of thepatient permits, elective surgery patients use the technique of PABD as much aspossible. Patients undergoing PABD of the experimental group is less averagedays of hospitalization, fewer adverse reactions, less post-operative infections,the prognosis is better. The total saved blood volume is huge, and the saved cost of blood transfusion is large. Clinicians take into account these effects whenpatients undergoing elective surgery need blood transfusion therapy.