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Description / Table of Contents: The use of deposited autologous blood instead of allogenic blood is recommended in cases of elective maxillofacial operations if the blood transfusion probability is more than 10%. As an alternative, the controlled intraoperative normovolemic hemodilution and the preoperative use of EPO (Erytropoetin) should be considered. In a retrospective study, we analyzed 438 patients who underwent orthognathic surgery. The perioperative blood loss was determined in order to calculate the transfusion probability in case of the acceptance of 7.5 g/dl hemoglobin as the critical value in patients without cardiac failures. Only four patients undergoing Le Fort I osteotomy (1.55%) or bimaxillary osteotomy (3.03%) had to be transfused. Therefore, the statistical transfusion need was clearly below 10%. Due to this, there was no general need for autologous blood donation. However, in individual cases with low hemoglobin and/or low blood volume, a transfusion need can be predicted. In those few cases, autologous blood donation may be indicated. However, in case of a more conservative indication to transfusion (hemoglobin 10 g/dl), more than 10% of the patients with bimaxillary osteotomies would have been transfused. Autologous blood donation is then indicated according to the German regulations for transfusion. If low hemoglobin values are accepted, the exact individual blood demand should be calculated, a blood saving operation technique should be used, adequate postoperative warding is necessary, and compatible allogenic red cell concentrates should be quickly available.

Description / Table of Contents: Abstract The separation of whole blood into components is the state-of-the-art in transfusion of allogeneic blood. The main reasons are the negative effects of the buffy coat and the need for FFP. Nevertheless, especially in Germany whole blood is being rejected more and more even as autologous blood. However, most of the negative effects of the buffy coat do not apply to autologous blood. Additionally, these patients usually do not develop coagulation disorders and therefore do not need plasma as a hemostatic component. On the other hand, separation into components of autologous blood leads to an increase of costs and to logistic problems that restrict autologous blood predeposit to a few institutions. Therefore, we have reviewed the literature in order to find a scientific basis for this. Methods. We analysed all articles listed by MEDLINE during the last 12 years that dealt with the quality of whole blood or red cell concentrates. In addition, all references were included that contributed relevant information to the topic. A total of 135 original articles, abstracts, reviews, letters or editorials were analysed that referred to standard preparations and storage media. In 48 papers the in vivo red cell survival was studied. 28 of which fulfilled the prerequisites to be included into a meta-analysis. The following in vitro parameters were also evaluated: pH, potassium load of the units, ATP and DPG concentration of the red cells. Results and discussion. Whole blood (resuspended in CPDA-1) and red cell units (stabilized in CPDA-1 or additive solutions) with a different buffy coat or leucocyte content have comparable pH values and red cell 2,3-DPG and ATP concentrations at the end of the approved storage time. The potassium load of a whole blood unit appears to be higher than red cell concentrates, but this is to some extent caused by the higher plasma content of whole blood and is not thought to be a clinically relevant problem for patients receiving only a few units. A number of studies demonstrate that dependent upon the leucocyte content of a red cell unit, leucocyte metabolites and enzymes are released and accumulate during storage. A detrimental influence on the integrity of the red cell membrane was found in several in vitro studies. Nevertheless, a significant improvement in red cell survival by leucocyte reduction was detected by only one group. Undoubtedly, non-hemolytic febrile transfusion reactions (NHFTR) are generally caused by an antibody-antigen interaction due to the transfusion of allogeneic buffy coat. On the other hand, there is some evidence that non-specific immunological mechanisms such as the release of histamine or cytokines are also capable of causing NHFTR. Thus, these reactions are expected to occur in autologous blood transfusion. However, so far, there are no data about the frequency and severity of these reactions and whether they are more likely to emerge after transfusion of blood units with a particular preparation. Blood transfusions can cause septic complications due to bacterial contamination of the transfused units. These fatal but rare complications may be reduced by pre-storage filtration of blood, but there is no indication that buffy coat reduction is effective. Three cases with septic complications have been reported after autologous transfusion, in two of which red cell concentrates (at least one was free of buffy coat) had been used. Thus, there is no justification for the conclusion that the risk of septic complications is increased by transfusion of whole blood. After all, whole blood and red cell concentrates exhibit only minor differences in relevant in vitro parameters. Hence, a higher incidence of adverse effects following the transfusion of autologous whole blood compared to autologous red cell concentrations is unlikely. Therefore, the 24 h in vivo recovery is considered to be the most valid criterion to assess the quality of red cell preparations. We summarized the results of eligible studies in a meta-analysis and concluded from these data that there is no statistical difference in the in vivo recovery of the transfused red cells between whole blood and filtered red cell concentrates suspended in additive solution. Red cell concentrates suspended in CPDA-1, particularly with a high hematocrit, show significantly worse red cell survival rates than whole blood and should not be in clinical use any more. Conclusion. Whole blood and buffy-coat-free red cell concentrates in an additive solution have an equal therapeutic efficacy. When restricted to a few units (i.e., 2–3), the transfusion of autologous whole blood does not show more frequent or more serious side effects than autologous red cell concentrates. Thus, whole blood can be regarded as the red cell preparation of choice for the majority of clinical settings in autologous transfusion.

Description / Table of Contents: Zusammenfassung 79 Patienten mit autoimmunhÄmolytischer AnÄmie vom WÄrmetyp (AIHA) und 7 Patienten mit positivem direkten Antiglobulintest ohne HÄmolyse wurden untersucht, um mögliche ZusammenhÄnge zwischen den Serumkonzentrationen von C3 und C4 und der Komplementbeladung der Erythrozyten zu erkennen. 23 der 79 Patienten mit AIHA wurden mehrfach wÄhrend des klinischen Verlaufs kontrolliert. Die verschiedenen klinischen Formen zeigten keine signifikanten Unterschiede der Serumkomplementwerte. Dagegen wiesen die FÄlle mit Komplementbeladung der Erythrozyten signifikant hÄufiger erniedrigte C3 und C4 Konzentrationen im Serum auf als solche mit alleiniger Immunglobulinlagerung. Die VerÄnderungen von C4 waren ausgeprÄgter als von C3, die Mittelwerte von C4 lagen signifikant niedriger in der Gruppe mit Komplementbindung. Bei gleichzeitiger Nachweisbarkeit von inkompletten WÄrmehÄmolysinen waren die Serumspiegel von C4 wesentlich niedriger als bei FÄllen ohne WÄrmehÄmolysine. WÄhrend des klinischen Verlaufs zeigten die C3 und C4 Konzentrationen eine enge Korrelation zur StÄrke der HÄmolyse.

Description / Table of Contents: Zusammenfassung Es wird über eine Modifikation der repetitiven zyklischen Filterleukopherese (RFL) berichtet. Im Vergleich zu der von De Fliedner und Mitarbeiter (1974) beschriebenen Methode ist sie technisch einfacher durchzuführen, erlaubt die Verwendung eines kommerziell erhältlichen Filtrationsbestecks und ist dadurch beträchtlich billiger. Die mittleren Granulozytenausbeuten bei 51 RFL von unkonditionierten Normalspendern betrugen abhängig von der Anzahl der Filtrationsphasen 1,7 bis 2,3×1010.