Optimal Blood Ordering for Solid Organ Transplantation / 대한수혈학회지

BACKGROUND: Currently brain dead solid organ transplantations are performed in several institutions, and these are extended in Korea. Especially liver transplantation requires such a large amounts of blood components including filtered and irradiated cellular components that blood bank should give a great support to provide them. For effective management and reducing workload of blood bank in solid organ transplantation, we evaluated the blood component usage according to the type of organ transplantation and suggest a guideline for its optimal blood ordering schedule. METHODS: From February 1995 to October 1997, 143 solid organ transplantations (18 adults and 7 pediatric liver transplants, 115 renal transplants and 3 heart transplants) were performed in Samsung Medical Center. We investigated amount of blood components requested by surgeons or anesthesiologists, and evaluated their usage, discard rate and C/T ratio (crossmatch to transfusion ratio) during perioperative, intraoperative and postoperative period for solid organ transplantation. In liver and heart transplantation, the usage of blood component according to the operative phases was also evaluated. RESULTS: All of the patients who underwent liver and heart transplantation and 15% of the patients who underwent renal transplantation were transfused with blood components during operation. For adult liver transplantation, 31.1 units of leukocyte-depleted red blood cells (LDRBC), 43.6 units of fresh frozen plasma (FFP) and 16.3 units of leukocyte depleted platelets (LDPC) on an average were transfused. Intraoperative salvage using Cell Saver was performed in liver transplantation and the volume of salvaged was 7127.6 mL which was equivalent to 28.5 units of RBCs. The C/T ratio of RBCs was 1.4. In pediatric liver transplantation, 4.8 units of LDRBC and 4.3 units of FFP were transfused with C/T ratio of 1.9. Two of 5 pediatric liver transplantation donors were transfused with 3 units of RBCs, 1.5 units of FFP and 1.0 unit of whole blood by preoperative autologous blood donation. Only 18 out of 115 patients who underwent renal transplantation were transfused with 2 units of RBCs and 2 units of FFP. The discard rate revealed over 60% and C/T ratio was 4.6-5.1 in renal transplantation. For the heart transplantation 1.3 units of RBCs, 5.6 units of FFP, and 7.3 units of LDPC were transfused. The C/T ratio was 3.8. CONCLUSION: Compared with foreign reports, slightly larger amount of blood components were used for liver transplantation, however similar amount were used for renal and heart transplantation. As the results of present study, we propose a guideline for optimal blood ordering schedule for solid organ transplantation considering the marginal safety : 40 units of LDRBC, 50 units of FFP, 20 units of LDPC and 8 units of Cryoprecipitate for adult liver transplantation; 5 units of LDRBC and 6 units of FFP for pediatric liver transplantation; 2 units of LDRBC, 6 units of FFP and 10 units of LDPC for heart transplantation. Additional requests of blood components for liver and heart transplantation might be decided considering the clinical situations.

Analysis of Surgical Blood Use in Operation at YUMC / 영남의대학술지

This study was performed to guide the effective utilization of blood and optimal blood ordering schedule for various elective surgeries, based on the analysis of 1,462 transfused surgical procedures and 5,933 blood units transfused during operation in the period of two years through January, 197 to December, 1988 at Yeungnam University Hospital. The frequency of transfusion, and mean transfused units were evaluated and recommended blood unit for each surgical procedure was proposed. We assure that the successful establishment of this guideline can lead to substantial monetary saving, reduced blood outdating, and a decreased blood bank workload with a more appropriate allocation of the technician's time and effort.