New "leap-frog" technique for autologous blood donation

Nineteen years of experience with autotransfusion for elective surgery in children: more troublesome than we expected

BACKGROUND

Under the rationale that children undergoing elective surgery are the best candidates for autologous blood donors because of their long life expectancy, aggressive donations of autologous blood, even from infants, have been reported. A number of problems are associated with the procedure, however, whereas the risks of homologous blood are very low.

STUDY DESIGN AND METHODS

From 1987 through 2005, of 5792 patients referred to blood transfusion services at two Japanese university hospitals for autologous blood donations, 314 children younger than 16 years old served as subjects for assessment.

RESULTS

Of 314 children, 7 were not suitable as autologous donors. In most cases this was due to uncooperative behavior. Over a follow-up period of 19 years, the authors encountered 53 cases (17.3%) of donation-related problems, and this rate was higher than the 6 percent rate recorded for adult cases (316/5305). Nine children suffered crucial complications such as vasovagal reactions, and one 14-year-old boy required a vasopressor drug. Important findings were that 6 of these were first-time donors, and the amount of blood drawn was under 10 percent of their estimated blood volume.

CONCLUSION

Of 53 donation-related problems, 9 (17.0%) were accompanied by marked hypotension. Drawing autologous blood from children has become easier with advanced devices; however, lessening of anxiety and tension are essential for the safety of children's autologous blood donation programs. Aggressive donation should be avoided.

Low frequency of observed anti-HLA among transfused preterm infants

BACKGROUND

Although low-birth-weight infants (LBWI) often receive multiple transfusions, there is controversial information on their development of antibodies against WBCs or platelets.

STUDY DESIGN AND METHODS

A total of 52 LBWI with birth weights less than 1500 g were randomly assigned to receive either RBCs that had been WBC- reduced (n = 25) or nonfiltered blood (n = 27). Serum samples collected from 37 infants at 3 months of age and from 30 children when they were 5 to 11 years old were tested. Anti-HLA was assayed with an anti-human globulin-augmented lymphocytotoxicity test against a panel consisting of 13 lymphocytes and against parental cells.

RESULTS

None of 52 transfused LBWI of either group developed anti-HLA (95% CI, 0%-6.8% for overall, 0%-13.7% for the WBC-reduced group, and 0%-12.7% for the nonfiltered group).

CONCLUSION

Multiply transfused LBWI rarely produced antibodies to HLA of blood donors and to noninherited maternal antigens. The benefits of WBC reduction to prevent HLA alloimmunization during infancy were not supported by this study and need further investigation.

Lack of difference in cytomegalovirus transmission via the transfusion of filtered-irradiated and nonfiltered-irradiated blood to newborn infants in an endemic area

BACKGROUND

It is accepted that white cells contained in blood components are the most significant source of cytomegalovirus (CMV) infection in immunocompromised and immunodeficient recipients.

STUDY DESIGN AND METHODS

To determine whether white cell filtration of blood would be effective in preventing infection among newborn transfusion recipients in a hyperendemic area, a randomized study was performed. All donor blood units were irradiated before issue to prevent posttransfusion graft-versus-host disease. Recipients were monitored for CMV infection by seroconversion (development of IgM anti-CMV) and CMV-DNA isolation.

RESULTS

Three (9%) of 33 infants who received filtered blood and 1 (5%) of 19 infants given nonfiltered blood were infected with CMV, as determined by the presence of IgM anti-CMV and/or CMV DNA isolation.There was no significant difference in the rate of CMV infection in the two groups.

CONCLUSION

The CMV infection observed in the study may come from other routes such as breastfeeding, rather than from transfusion. Our findings suggest that the routine use of white cell-reduction filtration to reduce the risk of transmitting CMV is unwarranted for neonates in endemic regions.

Autologous blood donation elective surgery in children

Studies were made on 59 children (cardiac 42, orthopaedic 13, miscellaneous 4) scheduled for autologous blood donation before elective surgery. The donor-patients' ages ranged from 3 to 15 years (mean 9.9 years) and their weights from 13 to 70 kg (mean 34 kg). All patients received 50-100 mg of oral iron sulphate per day. As a rule, about 10% of intravascular blood volume was drawn once a week. Before surgery, an average of 720 ml of autologous blood per patient was prepared. Two patients failed to donate autologous blood because of anxiety about the procedure; however, none of the donors was deferred due anaemia associated with the phlebotomy. Of the 53 patients undergoing surgery and participating in autologous predonation, 50 (94%) were able to avoid homologous blood transfusion. 600 ml of homologous blood were transfused to each of 2 orthopaedic patients and 400 ml to 1 cardiac patient. We conclude that a predeposit autologous transfusion programme is logistically possible in small children when the patients are cooperative.