Blood collection and transfusion in the United States in 1999

BACKGROUND

Collection, processing, and transfusion of blood and blood components in the US in 1999 were measured and compared with prior years.

STUDY DESIGN AND METHODS

Questionnaires were completed by 2040 blood centers and hospitals. Statistical procedures were used to verify the representativeness of the sample and to estimate national totals.

RESULTS

The total US blood supply in 1999 was 13,876,000 units (before testing), 10.1 percent greater than in 1997. It included 13,109,000 allogeneic units, 651,000 autologous units, and 116,000 red cell (RBC) units collected by apheresis. Transfusion of whole blood and RBCs increased by 7.6 percent to 12,389,000 units. Platelet (PLT) transfusions totaled 9,052,000 PLT concentrate equivalent units, of which 66.5 percent were PLTs from apheresis. In comparison with 1997, the total number of PLT units transfused was unchanged, whereas single-donor PLT units transfused increased by 6.7 percent and the transfusion of PLTs from whole blood (PLT concentrates) declined by 10.6 percent (a difference of approximately 400,000 units in each case).

CONCLUSIONS

The margin between transfusion demand and the total allogeneic supply in 1999 was 1,203,000 units, 9.1 percent of the supply. By comparison, the margin in 1997 was 7.2 percent, whereas in 1989 it was 13.8 percent. Similarly, the rate of blood collection in 1999 per 1000 population was 11.9 percent higher than the 1997 rate. During the same period, however, the rate of transfusion per 1000 population increased by 5.8 percent. Risk in the future lies primarily in the increasing demand for RBCs and further shrinkage of the supply-and-demand margin.

[Necessity for blood transfusion in head and neck surgery]

INTRODUCTION

Sometimes, use of blood products is necessary in head and neck surgery, but blood transfusion also entails risks for the patients and causes high costs for the department. Therefore, we examined the surgical procedures in our department and analysed how often transfusion of blood was necessary and which expenses were incurred.

METHODS

Of 3989 operations performed in 1989, 187 patients were found to be at an increased risk for blood loss. The costs for blood group analysis (euro 23.16), cross-testing (euro 13.91) and the transfusion itself (euro 70.35) were estimated in each patient.

RESULTS

In 1998 more than 60% of the 187 patients had undergone extensive head and neck surgery for advanced squamous cell carcinoma. Only 17 patients (<15%) received nearly 45% of all units of stored blood transfused that year. In patients who had undergone skull base surgery, the probability of receiving blood was 30%. The transfusion-related costs were estimated to be euro 20,000 during the observation period. Potential savings could have been achieved in cross-testing.

CONCLUSION

Preparations should be done on an individual basis. Such preparations are sometimes unnecessary even in patients undergoing surgical procedures with a high risk for blood loss.

Cost-effectiveness of recombinant human erythropoietin for reducing red blood cells transfusions in critically ill patients

OBJECTIVE

To examine the cost-effectiveness of using recombinant human erythropoietin (rHuEPO) to reduce red blood cells (RBC) transfusions in intensive care unit (ICU) patients.

METHODS

Decision analysis examining costs and effectiveness of using rHuEPO versus not using rHuEPO in a simulated adult medical/surgical/trauma (mixed) ICU. Two independent cost-effectiveness models were created based on the results of two multicenter studies that investigated the use of rHuEPO. Base case assumptions and estimates of effectiveness were obtained from these two studies. Mean cumulative doses of rHuEPO were 190,900 units and 102,400 units for studies 1 and 2, respectively. The models accounted for the deferral rate for allogeneic RBC transfusions, rHuEPO efficacy (the reduction in allogeneic RBC use), and adverse effects of rHuEPO and allogeneic RBC transfusions. Model estimates were obtained from published sources. Costs were expressed in 2002 US dollar (dollars) and effectiveness was measured using discounted quality-adjusted life-years (QALYs). A 3% discount rate was used. Probabilistic sensitivity analysis was conducted using second-order Monte Carlo simulation.

RESULTS

Incremental costs of using rHuEPO to reduce RBC transfusions amounted to 1918 dollars and 1439 dollars; incremental effectiveness values were 0.0563 QALYs and 0.0305 QALYs; and the cost-effectiveness ratios were 34,088 dollars and 47,149 dollars per QALY for studies 1 and 2, respectively. The model was most sensitive to the attributable risk of nosocomial bacterial infections per RBC unit. rHuEPO was cost-effective in 52.0% of the Monte Carlo simulations for a willingness to pay of 50,000 dollars/QALY.

CONCLUSION

rHuEPO appears to be cost-effective for reducing RBC transfusions in heterogeneous ICU populations, assuming RBC transfusions increase the risk of nosocomial bacterial infections.

The societal unit cost of allogenic red blood cells and red blood cell transfusion in Canada

BACKGROUND

There is a dearth of information about the cost of allogenic red blood cells (RBCs) and RBC transfusion in Canada in the aftermath of the Canadian blood system reorganization and the introduction of various safety measures. The unit cost of allogenic RBCs and RBC transfusion in Canada in 1994 was estimated at 152.17 US dollars. The objective of this study was to determine the unit cost of allogenic RBC transfusion in Canada from a societal perspective.

STUDY DESIGN AND METHODS

A cost-structure analysis using the cost information from 2001 through 2002 was used. Costs of blood collection, production, distribution, delivery (hospital transfusion service processing and patient administration), transfusion reaction management, and opportunity cost of donor's time were included in the analysis. Canadian Blood Services and Héma-Québec supplied the data for collection, production, and distribution stages. Delivery and transfusion reaction costs were collected from eight hospitals across six Canadian provinces. In-patient costs were assessed for the intensive care unit, emergency, general medicine ward, and operating room.

RESULTS

The aggregate mean societal unit cost of RBCs transfused on an inpatient basis in 2002 was 264.81 US dollars (95% confidence interval [CI], 256.29 dollars-275.65 dollars). The mean cost of blood collection, production, and distribution was 202.74 US dollars (95% CI, 199.63 dollars-204.31 dollars), the mean opportunity cost of donor time was 18.21 US dollars (95% CI, 17.11 dollars-21.63 dollars), the mean cost of hospital transfusion service processing was 16.65 US dollars (95% CI, 13.50 dollars-19.79 dollars), of RBC transfusion was 26.92 US dollars (95% CI, 25.33 dollars-28.52 dollars), and of transfusion reaction management was 0.29 US dollars(95% CI, 0.22 dollars-0.36 dollars). There were substantial variations in hospital transfusion service processing and RBC transfusion costs across hospitals.

CONCLUSION

The societal unit cost of RBC transfusion has doubled since 1994 to 1995. Further increases in unit costs would be expected as additional safety measures are introduced. This will have important financial implications for treating patient populations that require a high level of RBC transfusions.

Economic Analysis of an Intraoperative Cell Salvage Service

In the United States, the cost of erythrocyte transfusion exceeds 1.3 billion dollars annually. The fear of viral disease transmission popularized intraoperative salvage to reduce the use of banked blood. Although the economics of this technique have been questioned, the financial variables in providing an intraoperative autotransfusion service have not been analyzed. We designed mathematical models to determine the most cost-effective strategy based on hospital caseload. Four models were analyzed with a spreadsheet to project costs of an intraoperative autotransfusion service when fully or partially outsourced, performed by a full-time technician employee, or performed by a cross-trained employee. The Partially Outsourced model was more economical than the Fully Outsourced model when the annual caseload exceeded 185 cases. The New Employee model became more economical than the Fully Outsourced model when the annual caseload exceeded 110 cases. The Cross-Trained model was the most economical when annual caseload exceeded 55 cases.

IMPLICATIONS

Cross-training an employee as a cell salvage technician is more economical than outsourcing when caseload exceeds 55 per year.

The cost of allogeneic red blood cells - a systematic review

Several reports suggest that the cost of RBCs may have risen over time, but there exists very little published evidence of that. The objective was to determine whether published studies documenting cost data on RBCs suggest an increase over time and to assess the quality of cost studies. We used the terms 'cost', 'allogeneic/allogenic' and 'blood' to identify cost studies between 1966 and 2002 from Medline, ISIesource and Ingenta electronic databases. Furthermore, we manually searched a number of transfusion and health economics journals for completeness. We included studies that used an established methodology and conducted an economic evaluation using primary/secondary cost data to calculate the cost of RBCs and RBC transfusion. Studies without allogeneic RBCs as comparator were excluded. Two individuals independently reviewed the studies and included studies upon reaching a consensus. Fourteen studies qualified the selection criteria and were included in the review. Ten studies were identified from Medline, two from Ingenta, one from ISIesource and one was a conference paper. Of the 14 studies reviewed, 10 had focused on RBC transfusion and four had focused on both RBCs and RBC transfusion. Ten studies were from the US, and two each from Canada and the UK, respectively. Two studies had explicit objective of cost calculation, and others had calculated costs towards fulfilling other objectives. Most of the reviewed studies were dated and of poor quality. Despite these limitations, it appears that the cost of RBCs has increased over time in the UK, Canada and the US. More studies are needed to fully assess the trend of costs over time. Future cost studies should try to follow the economic evaluation guidelines for greater research implications.

Frozen preoperative autologous blood donation for heart transplantation at the Mayo Clinic from 1988 to 1999

BACKGROUND

Preoperative autologous blood donation (PABD) has been used to reduce the need for allogeneic RBC transfusion, decreasing risk and conserving supply. A frozen PABD program for heart transplant patients was instituted at the Mayo Clinic in 1988, but participation has steadily declined. The aims of this study were to determine how the availability of PABD influenced the transfusion RBC components, whether the availability of PABD reduced exposure to allogeneic RBC components, and the costs of providing PABD units.

STUDY DESIGN AND METHODS

A retrospective review of all heart transplant cases from 1988 to 1999 was performed (n = 141). Data on collection and transfusion practices were compared for patients with (n = 88, 62%) and without PABD (n = 53, 38%).

RESULTS

Total RBC transfusion requirements did not differ between the groups. Patients with frozen PABD received fewer allogeneic units, but they also had less blood salvaged and reinfused. Twenty patients (23%) completely avoided exposure to allogeneic RBCs in the PABD group versus three patients (6%) in the group without PABD. Although patients in the PABD group successfully donated a total of 423 units, 41 percent were discarded. Over 11 years, the need for 251 units of allogeneic RBCs was avoided ($27,610), but $283,500 was spent to have the frozen PABD units available.

CONCLUSION

PABD can be performed for heart transplantation, but it is expensive.

Individual timing of blood counts in G-CSF prophylaxis after myelosuppressive chemotherapy reduces G-CSF injections, blood counts, and costs: a prospective randomized study in children and adolescents

In children and adolescents, prophylactic application of G-CSF after myelosuppressive chemotherapy reduces the duration of neutropenia, of hospitalization, and of parenteral antibiotic treatment. In acute lymphoblastic leukemia, non-Hodgkin lymphoma, and solid tumors, G-CSF support allows dose intensification of chemotherapy. On the other hand, each G-CSF injection causes pain and costs. We set up the hypothesis that besides strategies as restricted indications, delayed start, lower doses, and stringent rules for discontinuation, individualized timing of blood count might optimize G-CSF prophylaxis. We randomized 64 cycles of G-CSF prophylaxis in eight children and adolescents being treated for acute lymphoblastic leukemia or solid tumors to standard twice a week or to individually timed blood counts. Primary study endpoints were the numbers of G-CSF doses and of blood counts, and the total costs of G-CSF support. Per cycle, individual timing of blood count resulted in a median of one G-CSF injection fewer [estimated population median (EPM) 1.40, 95% confidence interval (CI) 0.57-2.20] and one blood count fewer (EPM 1.00, 95% CI 0.74-1.33). The total costs of G-CSF support and of blood counts were thereby reduced by a median of US $ 152 per cycle (EPM 191, 95% CI 97-318). The results of this study suggest that individual timing of blood counts during prophylactic G-CSF support in children and adolescents undergoing chemotherapy for malignant disease can significantly reduce the number of injections and blood counts performed, thus resulting in less pain and lower costs. These findings need confirmation in a larger randomized trial.

Erythropoietin therapy versus red cell transfusion

Erythropoietin therapy was approved for use as a blood conservation intervention beginning in 1989 for patients with medical anemia and in 1997 for surgical patients. The adoption of this strategy has been rapid in some settings (such as renal failure patients), progressive in others ( eg, cancer patients), and slow in others (surgery patients, for instance). At the same time, the risks of blood transfusion have declined substantially whereas the costs of blood transfusion have increased significantly. The evolution of new techniques such as acute normovolemic hemodilution (ANH) and the novel erythropoiesis-stimulating protein (NESP) bring new options to allogeneic blood transfusion. Erythropoietin therapy, with or without autologous blood procurement, is undergoing new scrutiny as an alternative to blood transfusion. This is not only because of traditional concerns regarding blood risks but because of new blood inventory and cost considerations.

Cost analysis of erythropoietin versus blood transfusions for cervical cancer patients receiving chemoradiotherapy

PURPOSE

Red blood cell (RBC) transfusions or erythropoietin (EPO) can be used to evade the detrimental effects of anemia during radiotherapy, but the economic consequences of selecting either intervention are not well defined. The RBC transfusion needs during chemoradiotherapy for cervix cancer were quantified to allow comparison of RBC transfusion costs with the projected cost of EPO in this setting.

METHODS AND MATERIALS

For patients receiving pelvic radiotherapy, weekly cisplatin, and brachytherapy, the RBC units transfused during treatment were tallied. RBC transfusion costs per unit included the blood itself, laboratory fees, and expected value (risk multiplied by cost) of transfusion-related viral illness. EPO costs included the drug itself and supplemental RBC transfusions when hemoglobin was not adequately maintained. An EPO dosage based on reported usage in cervix cancer patients was applied.

RESULTS

Transfusions were given for hemoglobin <10 g/dL. Among 12 consecutive patients, 10 needed at least 1 U of RBC before or during treatment, most commonly after the fifth week. A total of 37 U was given during treatment, for an average of 3.1 U/patient. The sum total of the projected average transfusion-related costs was $990, compared with the total projected EPO-related costs of $3869.

CONCLUSIONS

Because no proven clinical advantage has been documented for EPO compared with RBC transfusions to maintain hemoglobin during cervix cancer treatment, for most patients, transfusions are an appropriate and appealingly less expensive option.

Validating billing data for RBC transfusions: a brief report

BACKGROUND

Administrative data are used often for research, but without validation of their accuracy. The validity of the billing for blood transfusion was assessed in one tertiary-care hospital.

MATERIALS AND METHODS

Patient discharge data were retrieved from a database containing demographics, diagnoses, and charges. There was random selection of 358 patients who were billed for RBC transfusion and 358 who were not, within a 2-month period. The blood bank's transfusion records were reviewed. Sensitivity was defined as the proportion of transfused patients who were billed, and specificity as the proportion of nontransfused patients who were not billed. Patient characteristics were compared by using Wilcoxon's rank sum test and the chi-square test.

RESULTS

Sixty-one transfused patients were not billed for the transfusion. No patient was billed without transfusion. Thus, the sensitivity and specificity were 83 percent (95% CI, 79-87%) and 100 percent, respectively. Nine patients who were not issued RBCs were appropriately not billed for RBCs, although the billing record suggests they had a procedure involving transfusion. These patients were called true-negative. The patients not billed were older (58 years vs. 55 years; p = 0.046) and less likely to have commercial insurance (5% vs. 15%; p = 0.035) than billed patients.

CONCLUSIONS

The billing for RBC transfusion in one large institution is reassuringly valid. The specificity is excellent, and the sensitivity is higher than that seen in other studies of coding validity.

Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy

Anaemia is a common occurrence in patients with cancer and contributes to the clinical symptomatology and reduced quality of life (QOL) seen in cancer patients. Many aspects of reduced QOL, including fatigue, are known to be associated with suboptimally low levels of haemoglobin. Even mild-to-moderate anaemia adversely affects patient-reported QOL parameters. Red blood cell transfusions are associated with many real and perceived risks, inconveniences, costs, and only temporary benefits. Recombinant human erythropoietin (rHuEPO) is an effective therapy to increase haemoglobin values in over half of anaemic cancer patients receiving concurrent chemotherapy. These increased haemoglobin values are closely correlated with improvements in QOL. Despite these objectively defined benefits, less than 50% of anaemic patients undergoing cytotoxic chemotherapy receive rHuEPO, in contrast to patients with chronic renal failure on dialysis, where anaemia is universally and aggressively treated to more optimal haemoglobin values. However, there are several barriers that may limit more widespread use of rHuEPO. These include inconvenience associated with frequent dosing; failure of a large proportion (40 to 50%) of patients to respond; relatively slow time to response; absence of reliable early indicators of response; and current lack of rigorous pharmacoeconomic data demonstrating cost-effectiveness. Darbepoetin alfa is a novel erythropoiesis stimulating protein (NESP) that is biochemically distinct from rHuEPO, and which has been proven to stimulate red blood cell production. The molecule has a 3-fold longer half-life and increased biological activity that will allow less frequent dosing, facilitating improved management of the anaemia of cancer. With this new option for therapy, further avenues of investigation should lead to renewed interest in the clinical benefits of optimal haemoglobin levels for patients with cancer.

Utility of routine postoperative laboratory studies in patients undergoing potentially curative resection for adenocarcinoma of the colon and rectum

In an effort to lower healthcare costs, this study was undertaken to evaluate the utility of routine postoperative (PO) laboratory studies and determine whether abnormalities alter patient (PT) care. This was a retrospective review of 105 PTs undergoing elective curative resection for colorectal cancer. A serum electrolyte and liver panel and a hematologic panel were drawn in all PTs. OF 8749 total laboratory values obtained, 5894 (67%) were normal. Two of these (0.03%) elicited a therapeutic intervention. Of the 2004 values that were low (23%), 103 (5.1%) elicited a therapeutic response. Of the 851 that were high (10%), 21 (2.5%) elicited a therapeutic response. Of 2089 preoperative laboratory values, 252 (12%) were abnormal, but in only 15 incidences in 9 PTs was any action taken. Three PTs required potassium supplementation and 6 PTs were transfused packed red blood cells before surgery. In the PO period 2603 laboratory values of 6660 obtained (39%) were abnormal. Of these, 735 (28%) were high and 1868 (72%) were low. Twenty of 735 (27%) high values triggered a therapeutic response that most commonly required administration of insulin for elevated serum glucose in 17 of 197 occasions in five diabetic PTs. On three occasions potassium was removed from intravenous fluids. Five of 275 (1.8%) low calcium values were treated in five patients. Potassium was replaced in 17 of 32 occasions in 14 patients where it was low. In this group of PTs, PO serum potassium, hemoglobin levels, and serum glucose in diabetics were the only values important in making therapeutic decisions. If laboratory studies can be streamlined into only those necessary, substantial savings in health care will be seen without sacrificing quality medical care.

Cell salvage and leucodepletion

Cell salvage has been used as a method of blood conservation for more than three decades. Although the principles and development of the Latham bowl had occurred in the 1960s, it was not until the early 1970s that washing of the concentrated red cells was introduced and a product that was universally acceptable was obtained. The last 25 years have seen little in the way of development of cell salvage, although significant refinement has taken place. Although the simple picture of cell salvage involves removal of the buffy coat, including platelets and leucocytes, in practice there are reports of great variation in the removal of these cells. Most recent studies suggest that there is very little removal of leucocytes by cell salvage. The leucocytes that remain in the red cell suspension following cell salvage have undergone significant morphological changes and the surface expression of leucocyte adhesion receptors increases dramatically during the process. There is little evidence that removal of these activated leucocytes has any significant clinical benefit. Although leucofiltration of blood before storage has been shown to be an extremely safe process, 'bedside leucofiltration', including leucofiltration of cell salvage blood, may not be without problems. Reports of hypotensive events while receiving blood products through a bedside leucocyte reduction filter have emerged during the last few years. This may be due to bradykinin production following platelet exposure to negatively charged leucocyte filters.

Evaluation of dosed red blood cell units collected with Gambro BCT--TRIMA

The increasing need of collecting high quality blood components and of improving the overall productivity of a blood centre requires the utilisation of a new innovative process that combines high speed collection with an automated process and blood component tailoring to fit individual patient requirements. We collected dosed Red Blood Cell (dRBC) units on 64 donors, eligible as regular donors on the Gambro BCT TRIMA using the dRBC collection protocol. The collection target was set to 180 ml packed Red Blood Cells (pRBCs) in 225 ml total collection volume (n = 7), or 300 ml pRBCs in 375 ml total collection volume (n = 33) or 360 ml in 450 ml (n = 24), depending on donor's hematological profile and blood volemia. Saline was infused as the replacement fluid at a 120%) collection:infusion ratio. Donor per cent hematocrit was (mean +/- S.D.) 43.7 +/- 4.0% and TBV = 4.99 +/- 0.69 1. The procedures yielded 100 +/- 6% of predicted yield, with a hematocrit of 78.2 +/- 6.6% in 29 +/- 3 min. Hb content was 99.9 +/- 21.8 in all procedures, or 61.5-94.4-118.6 g in the three groups, respectively. After the addition of the SAG-M storage solution, the hematocrit was 56.3 +/- 6.2%. No adverse reactions have been reported by the donors and all pPRBC units were transfused to patients without any transfusion reaction being reported by clinicians. The dRBC protocol is well tolerated by donors without any side effects, other than normal effects of regular blood donation. Higher pRBC productivity can be reached with a safe and automated process in conjunction with a high and consistent product quality easily matching the donor collection criteria and pRBC unit standards. Tailoring of pRBC units can result in an improved patient transfusion support.

[Improvement in the technology of washing erythrocyte-containing transfusion media]

A new device for preparing washed red cell components was proposed by the Sintez Co., Kurgan. The disposable containers were evaluated at the Center of Blood and Tissues, Military Medical Academy. The new system was found to be more effective, time-saving, cost-effective and decreased the risk of infectious complications as compared to the traditional methods for washing red cell components. Thus, the new device can be recommended for wide use in transfusion medicine.

Relative cost of autologous red cell salvage versus allogeneic red cell transfusion during abdominal aortic aneurysm repair

The costs of washed autologous red cell concentrate obtained by intraoperative red cell salvage were compared to the costs of allogeneic packed red cell transfusion during 110 consecutive abdominal aortic aneurysm repairs. The mean volume of scavenged blood during elective procedures was 1350 ml (range 350 to 6675 ml, n = 90) and emergency procedures 2750 ml (range 750 to 9400 ml, n = 20). The mean volume of processed (washed) blood returned during elective repairs was 759 ml (range 150 to 2900 ml, n = 51) and emergency repairs 1117 ml (range 0 to 4100 ml, n = 20). During elective repairs, the cost of routine autologous red cell salvage ($151 per 285 ml unit) was only slightly greater than the estimated cost of cross-matched, leucocyte-reduced, allogeneic blood ($143 per 285 ml unit). During emergency repairs, washed autologous red cells ($83 per 285 ml unit) were less expensive than allogeneic packed red cells. These findings indicate that, compared with the use of allogeneic packed red cells, red cell salvage during emergency abdominal aortic aneurysm repair can be justified on an economic basis alone, and that routine red cell salvage during elective repair can achieve the benefits of autologous blood at little extra cost to the community.

Financial analysis of chronic transfusion for stroke prevention in sickle cell disease

Chronic red blood cell transfusion can prevent many of the manifestations of sickle cell disease. The medical costs of chronic transfusion and management of associated side effects, especially iron overload, are considerable. This study was undertaken to evaluate the financial impact of chronic transfusion for stroke prevention in patients with sickle cell anemia. Outpatient charges pertaining to hospital-based Medicare uniform bill (UB-92) codes, professional fees, and iron chelation were evaluated. Data were collected on 21 patients for a total of 296 patient months (mean, 14; median, 14 months/patient). Charges ranged from $9828 to $50 852 per patient per year. UB-92, chelation, and physician-related charges accounted for 53%, 42%, and 5% of total charges, respectively. Of UB-92 charges, 58% were associated with laboratory fees and 16% were related to the processing and administration of blood. Charges for patients who required chelation therapy ranged from $31 143 to $50 852 per patient per year (mean, $39 779; median, $38 607). Deferoxamine accounted for 71% of chelation-related charges, which ranged from $12 719 to $24 845 per patient per year (mean, $20 514; median, $21 381). The financial impact of chronic transfusion therapy for sickle cell disease is substantial with charges approaching $400 000 per patient decade for patients who require deferoxamine chelation. These data should be considered in reference to cost and efficacy analyses of alternative therapies for sickle cell disease, such as allogeneic bone marrow transplantation.

Cord blood as a source of autologous RBCs for transfusion to preterm infants

BACKGROUND

This prospective study was conducted to gain experience as to whether it is technically possible to produce autologous RBCs in additive solution from cord blood (CB), to optimize the blood supply for preterm infants.

STUDY DESIGN AND METHODS

CB was collected from 47 infants with a mean (+/- SD) birth weight of 1717 (+/- 699) g. Whenever possible, RBC components were prepared by standard centrifugation using a six-bag system. All samples were put in sterility testing quarantine for 5 days, and a maximum storage of 14 days from collection to transfusion was specified. The babies were given either the autologous RBCs or standard allogeneic RBC concentrates, if autologous blood was not available.

RESULTS

In 81 percent of the samples, autologous RBC components could be processed (vol, 7-87 mL; Hct, 31-82%). But within the group of extremely low birth weight infants (body weight <1000 g), a mean CB net volume of only 37 mL was collected, and the RBC preparation was successful only in exceptional cases. Three CB samples (8.6%) tested positive in sterility testing. Of the 47 infants, 21 were treated with a total of 62 allogeneic and 4 autologous RBC transfusions. Most infants with a body weight over 1400 g did not need any RBC transfusion.

CONCLUSION

The preparation of autologous RBCs from the CB of preterm infants is technically possible in principle. However, major concerns must be raised as to whether such preparations are of benefit in ensuring safe care of neonates with blood components, with respect to the high rate of bacterial contamination and the limited availability in babies with low birth weight.

[Prevention of neonatal anemia with recombinant human erythropoietin: a cost-benefit analysis]

A few years ago recombinant human erythropoietin (rh-EPO) has been introduced for the prophylaxis of anaemia of prematurity. Aim of this controlled study was a cost-effectiveness analysis of the prophylaxis with rh-EPO versus sole transfusion with packed red blood cells. In the study group 33 infants (gestational age 30 +/- 2 weeks, birthweight 1217 g +/- 244 g) were treated with rh-EPO beginning on the fifth day of life for a six week period. They received 750 IE rh-EPO/kg/week and transfusion with packed red blood cells when indicated. In the historic control group 33 infants (gestational age 29.2 +/- 1.9 weeks, birthweight 1181 g +/- 205 g) did not receive rh-EPO, patients were only transfused. Indication and guidelines for transfusion were identical for both groups. The number of transfusions was registered after 2 and 4 weeks of life and by the time of hospital discharge. The cost analysis was carried out by using current prices for packed red blood cells including material and processing and prices for rh-EPO (Neo-Recormon, Boehringer Mannheim). Infants in the study group received 1.39 +/- 1.94 transfusions per patient while patients in the control group needed 2.7 +/- 1.93 transfusions per patient (p < 0.05). Cost for treatment was slightly increased in the study group (DM 536,- vs. DM 459,-). Prophylaxis of anaemia of prematurity with recombinant human erythropoietin proved to be effective. Compared with sole blood transfusion treatment, expenses for the prophylaxis with rh-EPO were only little higher.