On Mar. 22, 2000 the e-Network membership was asked if there was available about autologous blood utilization in California? Given the fact that California physicians have the Paul Gann Act requirement to fulfill it would seem that California data might be different from other states. Specifically, are there data on the use of autologous blood in cancer surgery and non-cancer surgery. A division of surgery at a large medical center is looking for some data to be used as a benchmark.

The following answers were submitted in response to the above question.

1. I'm almost positive there are no statewide data on this issue.  Quite a while back there was national data based on responses to a CAP survey. I think individual transfusion services may have data, but I'm not sure how current some of it may be. I'll await the interesting responses to the e-network from the transfusion services. My gut feeling from informal conversations with transfusion service directors is that autologous blood outdating/wastage would be in the 40-60% range.

2. I am unaware of any such data specific for California; however, EL Wallace, WH Churchill et al periodically review and publish transfusion data for the entire US. In their analysis they collect data by region but do not publish the results that way. Nonetheless, they may have some information. One of their publications was in Transfusion 1998;38625-36.

3. I had done a blinded questionnaire with a question about the use of autologous blood while I was at Sacramento Blood Center. I was able to obtain feedback from all of the hospitals served by the blood center (about ?35 at the time, I think). I don't remember exactly what the results were; but if you contact the blood center they may be able to see if the information is still around.

4. I'm not sure we have much hard data, from a blood center's perspective, but assume some hospitals must. I can provide some observations. We reached a peak of autologous (AT) collections several years ago of 14,000 units. By working through our area hospital transfusion committees, on which virtually all we have one of our blood center physicians, we have reduced this to about 8,000 units now. We estimated that 70% of the units were not being transfused since we "encouraged" the use of the same "transfusion trigger" for AT as allogeneic units. By using the data of Kanter et al., we pushed for not drawing units on procedures which rarely used blood so reduced the collections for hysterectomies and other operative procedures which
didn't use blood if no AT units were available. We have the impression that we are collecting for procedures which often need blood such as hip replacements and cardiac surgery now. The usage rate is on the order of 50% which I think is appropriate since it is equivalent to a Crossmatch to Transfusion C/T ratio of 2:1, a common "benchmark" for many hospitals.

5. A recent study in which I participated looked at the use of autologous blood in patients undergoing radical retropubic prostatectomy for cancer. We found that 64% of autologous units were discarded or inappropriately transfused during surgery. See, O'Hara Jr JF, Sprung J, Klein EA, Dilger JA, Domen RE, Piedmonte MR. Urology 1999;54:130-34. Additionally, the paper included cost analysis data.

6. Don't know about utilization. Our draws are down from 9-10% in 1992 to 4-5% in 2000.

7. It is an interesting question. Would it be worth trying to put together a survey?

8. Here in the Stanford Transfusion Service, 60% of the autologous units that we receive are transfused, and approximately 5% of all RBCs transfused are autologous.

9. And the Final Answer (not submitted by Regis Philbin): We did a study in 1995. Most of our patients are Orthopedic. Of 855 AT units collected, only 372 were used. (43.5%). The study involved 443 patients and 158 physicians, of which 69 did not use any of the blood they ordered.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator