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For surgical patients transfusion of autologous blood (AB) is the most useful of measures to reduce patient's exposure to homologous blood(hb). In our Institute an autotransfusion program was started in 1982 utilizing all the autotransfusion techniques currently available. The integrated use of the techniques offered to the majority of the patients the possibility of receiving AB (98% of the elective surgery patients) and a consistent conservation of HB has been achieved (60-70%). However 42% are still exposed to some HB.Critical parameters that render the patients unable to fullfill the anticipated transfusion needs with the current ab transfusion techniques are: the patient's ability to predonate sufficient AB prior to surgery and the amount of blood transfused intraoperatively that in turn depends on different "transfusion trigger". In our Institute over 50 % of all the blood units are transfused the day of operation (60% being ab, 40% hb) and 50% postoperatively (only 33% being ab).For this reason, a clinical application for the oxygen-carrying products can be the replacement of the blood lost during, or immediately after the operation permitting the surgeon to operate safely at a lower Hct levels, thereby delaying the transfusion of blood and saving the AB obtained.

An increase in total and low density lipoprotein (LDL) cholesterol concentrations is related to the incidence of cardiovascular heart disease. The purpose of this study was to compare the efficacy and safety of pravastatin, an HMG-CoA reductase inhibitor, versus gemfibrozil, a fibrate, in the treatment of primary hypercholesterolaemia. 855 subjects (males and females, aged between 18 and 70 years) with total cholesterol (TC) concentrations > 240 mg/dl and triglyceride (TG) concentrations < 250 mg/dl were enrolled. After a pretreatment diet period, patients received either pravastatin 20 mg/day (659 patients) or gemfibrozil 1200 mg/day (196 patients). At the end of the 12-week treatment period, reductions in TC (−23%) and LDL-C (−31%) were noted in the pravastatin group. Gemfibrozil reduced TC by 16% and LDL by 20%. High density lipoprotein (HDL) cholesterol concentrations increased in a similar way in the two groups: pravastatin +10%, gemfibrozil+11%. Triglycerides decreased by 14% with pravastatin and by 22% with gemfibrozil. Pravastatin and gemfibrozil were both well tolerated. No significant adverse events or variations in laboratory parameters occurred during this study.

Background and objectives: Intravenous (i.v.) Recombinant erythropoietin (Epoetin alfa) is effective in allowing autologous blood donation in patients unable to donate because of anemia. We undertook this open pilot study in order to asses whether a low subcutaneous (s.c.) dose of Epoetin alfa would prove as effective and well tolerated as the higher i.v. dose. Such a move would also decrease costs. Materials and methods: A total Epoetin alfa s.c. dose of 800 IU/kg was compared with a total i.v. dose of 1,800 IU/kg. Twenty-two rheumatoid arthritis patients, unable to donate because of hemoglobin (Hb) &lt;11 g/dl, received 300 IU/kg of IV Epoetin alfa twice weekly for 3 weeks (11 patients), or 100 IU/kg of s.c. Epoetin alfa twice weekly for 3 weeks plus an i.v. bolus of 200 IU/kg of Epoetin alfa at the first visit (11 patients). At each visit, all patients received 100 mg of i.v. iron saccharate and when the hematocrit (hct) 34%, 350 ml of autologous blood (AB) were collected. Results: No significant differences were observed between the 2 groups of treated patients in terms of units of AB collected (2.6±0.6 vs. 2.5±0.5 units for i.v. and s.c. groups, respectively), ml of RBC produced during the study period (291±99 vs. 337±65 ml for the i.v. and s.c. groups, respectively), or in the degree of reduced exposure to allogeneic blood in comparison with the control group. Conclusions: Lower dose of Epoetin alfa (reduced by 56%), supplemented by i.v. iron, is as effective and well tolerated as higher doses administered i.v., supplemented by i.v. iron.

A successful autologous program should enroll all appropriate patients, conserve homologous blood and minimise the exposure to the risks of donor blood.A program of autotransfusion and proper use of blood has been implemented since 1980 with the objectives to include all eligible patients and to transfuse autologous blood only. The following strategies were adopted: critical review of transfusion indications; control of overtransfusion; avoidance of waste; systematic and integrated use of all autotransfusion techniques currently available.Results in 1992 in elective surgery: 98% enrolment, 75% blood conservation. Exposure to homologous blood was completely avoided in 53% of the cases.

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.