The Journal of Bone and Joint Surgery, Vol 74, Issue 5 652-658, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Autologous transfusions for orthopaedic procedures at a children's hospital
MB Simpson, G Georgopoulos, E Orsini and RE Eilert
Children's Hospital, Denver, Colorado 80218.
We conducted a critical review of the use of autologous transfusions in
orthopaedics at a tertiary-care children's hospital. The cases of 198
children who deposited blood before an orthopaedic operation were analyzed.
There were 175 children who were enrolled in the program of preoperative
deposit of autologous blood who later needed transfusion of blood; 73 per
cent of them received only autologous blood. Seventy patients also had
intraoperative salvage. We were unable to document a proved benefit of
intraoperative salvage of blood in this group of patients. Forty patients
had some difficulty donating autologous blood preoperatively, but these
problems were rarely serious. Major human errors occurred in thirteen
patients and resulted in some patients receiving homologous transfusions
while autologous blood components were still available. Fifty-five (40 per
cent) of all of the transfusions were administered in clinical
circumstances that failed to meet generally accepted criteria for
transfusion, and fifty-four (38 per cent) of the postoperative transfusions
also failed to meet these criteria. This was true of the homologous
transfusions in the study as well. Although an autologous blood transfusion
is a generally safe procedure, it is not without risk, and human errors can
occur. In light of the potential complications, surgeons should adhere to
the standard indications for transfusion when administering autologous
blood.
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