HOMOLOGOUS BLOOD TRANSFUSION IS NOT REQUIRED IN SURGERY FOR ADOLESCENT IDIOPATHIC SCOLIOSIS

Abstract

There is an increasing awareness of the need to avoid of homologous blood transfusion in elective surgical practice. This stems from a better appreciation of the adverse effects of homologous blood transfusion and increasing pressure on blood stocks because of increasing restrictions on potential donors.

This study examines the effect of using modern blood conservation methods on the subgroup of our patients having surgery for adolescent idiopathic scoliosis. We chose this group because it is a homogenous group of patients of similar age, all of whom had major surgery of a similar severity, and in whom there were few contraindications to our blood conserving strategies.

We studied 78 consecutive patients with adolescent idiopathic scoliosis who underwent surgery. They were divided into two groups. Patients in the study group had one or more modern blood conservation measures used perioperatively. The patients in the comparison group did not have these measures.

There were 46 patients in the study group and 32 in the comparison group. Eight patients who had anterior only surgery, were excluded. The two groups did not differ in age, body weight, and number of levels fused or the type of surgery.

Only 2 patients in the study group were transfused with homologous blood and even these transfusions were off protocol. Wastage of the autologous predonated units was minimal (6/83 units predonated). In contrast all patients in the comparison group were transfused homologous blood. There was significant decrease (p = 0.005) in the estimated blood loss when all the blood conservation methods were employed in the study group.

Using blood conservation measures, lowering the hemoglobin trigger for transfusion and education of the entire team involved in the care of the patient can prevent the need for homologous blood transfusion in patients undergoing surgery for adolescent idiopathic scoliosis.