The usefulness of autologous blood transfusion for urologic surgery

199～2001年に輸血が必要であることが予想され待機手術が可能であった症例で, 厚生省のガイドラインに適合しインフォームドコンセントが得られた27例(男25, 女2)に対し術前に自己血貯血を行った.貯血式自己血輸血施行前は, 膀胱全摘除術, 前立腺全摘除術はその約半数強に輸血が必要であった.術後安静時の至適Hb値は10g/dl程度といわれているが, それには前立腺全摘除術では800mlの自己血があれば殆どの症例(17例中16例)で同種血輸血が不要であった.膀胱全摘除術では同種血輸血回避率は60%であった.同種血輸血を行った4例中, 術前貧血により出血量が529mlであったが同種血を輸血した症例と, 術翌日Hb値が11.0g/dlであったが同種血輸血を行った症例を除けば貯血群の同種血輸血回避率は75%(6/8)であり非貯血群の27%と比較して有意に改善した.両術式は貯血式自己血輸血の良い適応であり, 貯血量は800mlが適当と考えられたTo avoid potential risks associated with homologous blood transfusion including viral infection and graft versus host disease (GVHD), autologous blood donations have been promoted in urologic surgery. We assessed its necessity in the patients undergoing radical retropubic prostatectomy and total cystectomy. A total of 27 patients ranging from 54 to 78 years old donated 400 to 1, 200 ml of blood prior to radical prostatectomy (17 patients) and total cystectomy (10 patients). Recombinant erythropoietin was administered in 26 out of 27 patients. The mean hemoglobin concentration was 14.1 g/dl before donation and 12.8 g/dl before operation. The mean volume of surgical blood loss was 1, 659 ml ranging from 529 to 2, 990 ml in total cystectomy, and 1, 438 ml ranging from 553 to 2, 841 ml in radical prostatectomy. Overall, 22 out of 27 patients (82%) did not require an additional homologous blood transfusion. In conclusion, autologous blood donation is a safe and useful method to avoid homologous transfusion in radical prostatectomy and total cystectomy. Eight hundred ml of blood donation is suggested to be appropriate prior to these surgeries