Original Title: La hemodilución y la recuperación sanguínea perioperatoria

Authors' objectives: Analyse the effectiveness, safety and costs of haemodilution and perioperative blood recovery. Gather data on the use of perioperative autologous transfusion in the Basque Health Service.

Authors' results and conclusions: Randomised clinical trials that compare the different alternatives for autologous transfusion compared to other options, usually include small samples of patients and concentrate on the analysis of the impact of the different options in avoiding the donor blood transfusion and do not assess the final impact on the health of patients. In view of these studies, it can be stated that there is no sound scientific evidence to demonstrate that, from the point of view of the final result on health, an autologous transfusion option is better than the donor blood transfusion, or the option not to transfuse, for the different situations or surgical procedures in which a considerable loss of blood is expected. A number of different surveys show that perioperative autologous transfusion techniques have a clear impact on a reduction in the probability of the patient receiving donor blood. On the other hand, a deficiency is detected in the information system that allows the routine analysis of the use of different forms of transfusion in patients treated in the Basque Health Service.

Authors' recommendations: The decision to use blood in programmed surgery, or not, either with autologous transfusion or donor blood, must be decided by each individual patient, bearing in mind his/her clinical circumstances, the values of variables such as his/her haematocrit or concentration of haemoglobin, and the blood which is expected to be lost during the operation. Although the risks associated with the different forms of transfusion are very small nowadays, they must be taken into consideration, and so both the use of autologous transfusion and donor blood should be restricted to cases in which these are considered to be beneficial for the each patient and the routine use of these techniques is not justifiable. We recommend that the Basque Health Service develop information systems that enable the routine analysis of the different forms of blood transfusion. We also recommend the development of clinical practice guides or protocols on the correct use of blood transfusions, both of the patient himself/herself and of donor blood, with the participation of professionals of the Basque Health Service and Scientific and Professional Societies. We recommend that the development of the aforementioned guidelines begin with surgical procedures that are either the most frequent procedures or the ones in which a greater variability of criteria and use of the different blood transfusion options is detected in hospitals in the Basque Health Service, specifically in operations of prosthesis of the hip and knee, as these are also the operations that require the highest consumption of blood units.

Authors' methods: A review has been made of the scientific evidence on the efficiency, effectiveness and safety of perisurgical autologous transfusion strategies. A bibliographical search was made (completed on May 14 2001) of clinical trials that provide data on the effectiveness and safety of the different transfusion strategies in the following computerised databases: Medline, Spanish Medical Index, Cochrane Library, and the databases of the NHS - Centre for Research and Dissemination of York. In order to determine the degree of use of different blood transfusion techniques in the Basque Health Service, an analysis of computerised databases in the Basque Health Service and a structured interview-based survey of the personnel of hospital blood banks, in Haematology and Anaesthetics Services and in several Surgical Services of different hospitals in the Basque Health Service were used as strategies.

Project Status: Completed

Year Published: 2002

URL for published report: https://www.euskadi.eus/contenidos/informacion/2002_osteba_publicacion/es_def/adjuntos/2002/d_02-07_hemodilucion.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)