Personalized Approach to Define Transfusion Support to Surgical Patients

Abstract

Preoperative autologous blood donation (PABD) is accepted as a standard of care to reduce the risk of allogeneic blood transfusion. However, autologous blood is considered more costly than allogeneic blood. PABD can be made more cost-effective by reducing the cost of collection and by avoiding overcollection of units. When MSBOS and SOPCAB are used to identify and exclude from PABD procedures associated with low transfusion requirements, and to define the number of units to be collected, the overall AB wastage is still around 15% (ranging from 6% to 15% for different surgical procedures). To optimize the PABD program we have developed a more personalized approach to define each patient's transfusion requirement based on the predicted blood loss in mL of RBCs, calculated per surgical operation in the previous 6-12 months, along with the blood loss that the patient can tolerate. The latter depends on the baseline circulating RBC mass and the RBC mass compatible with the patient's clinical and cardiocirculatory condition. To fulfill transfusion requirements for each patient the most effective strategy can be selected according to the type and time to surgery, PABD applicability; age and clinical status of the patients taking into account what each of the different techniques can provide in terms of volume of RBCs produced or conserved.