Preoperative autologous blood donation in patients with rheumatoid arthritis: Analysis on the effectiveness in increasing red blood cell mass

Background: Analysis on the effectiveness of preoperative autologous blood donation (PABD) on increase in red blood cell mass (+RBC) in patients with rheumatoid arthritis IRA). Patients and Methods: 199 RA patients (52 men and 147 women) participating in a PABD program prior to primary or revision arthroplasty of the hip or knee joint were included into the study. RA of the patients was known for many years and diagnosed according to the criteria of the American Rheumatism Association. Data were collected either retrospectively from the patients' records or from actual records of patients being scheduled for PABD and surgery. Patients' ability to predeposit was verified by an anesthetist in charge of the autologous blood bank. Patients considered suitable for this elective surgical intervention were suitable for PABD as well according to the standard criteria for PABD (compensated organ function, no signs of systemic infections, relevant laboratory parameters within their physiological limits except for a 'normal' hemoglobin/hematocrit (Hb/ hct) level), and the ASA physiological status score. Data on +RBC were analyzed for differences between men and women as well as between manual and mechanical PABD. Statistical significance was considered if p < 0.05 (with Bonferroni correction where appropriate). Results: When starling with PABD, the hct of the patients amounted to hct(init) = 33.6 +/- 3.9%; immediately before operation, hct was hct(praop) = 30.7 +/- 4.0% (p < 0.05). +RBC for all patients was 51 +/- 82 mi, with no difference between men 145 +/- 97 mi) and women 153 +/- 76 mi). The interval between donation and surgery (IDOP) was 18.3 +/- 12 days for all patients, with no difference between men (17.6 +/- 11 days) and women (18.6 +/- 12 days). 48.7% of the patients generated a +RBC of less than or equal to 50 mi, while 13.0% only produced a +RBC of >150 mi, including those 4.5% of patients generating +RBC at least equal to 1 U of packed red blood cells (190 mi). Patients with mechanical PABD generated a higher +RBC than those with manual PABD (70 +/- 68 mi Versus 38 +/- 88 mi; p < 0.05); IDOP did not differ between both groups (mechanical PABD 19 +/- 10 days, manual PABD 17 +/- 14 days). Among a variety of parameters, only patient's RBC mass(init), IDOP, and RBC mass(donated) were shown to have an impact on +RBC; neither age nor Bender nor ASA physiological status score were of relevance for +RBC. Conclusions: Our analysis demonstrates that in RA patients the 1-unit PABD concept is poorly effective in increasing total RBC mass. To rise effectiveness, IDOP should be prolonged to at least 4 weeks prior to surgery, and blood volume(donated)/RBC mass(donated) should be increased in order to stimulate erythropoiesis more intensively. Additionally, our data suggests to perform only 1 PABD in RA patients, but with a blood volume(donated)/RBC mass(donated) being greater than in the routine PABD procedure.