Correspondence

Transfusion Medicine

N Engl J Med 2002; 347:538-539August 15, 2002

Article

To the Editor:

We learned from an online publication of the Network for Advancement of Transfusion Alternatives1 that Goodnough and colleagues cited data from the work of our group2 in a 1999 review article in the Journal to support the hypothesis that there is no “meaningful difference in outcomes between autologous blood donation and acute normovolemic hemodilution” with regard to the reduction of homologous transfusion requirements.3 The data they present, however, are not the data we reported, nor is the conclusion they draw from these data ours.

We studied the efficiency of autologous transfusion methods in patients undergoing total hip arthroplasty, comparing groups of patients randomly assigned to preoperative autologous blood donation, cell salvage, or acute normovolemic hemodilution with a control group of patients who did not receive autologous transfusion. Homologous transfusion was required in 2 of 16 patients who donated blood before surgery, in 8 of 16 patients who received cell salvage, in 15 of 16 patients who underwent acute normovolemic hemodilution, and in 10 of 15 patients in the control group. Only the difference between the group of patients who donated blood before surgery and the control group was statistically significant (P<0.05). Thus, we concluded that preoperative autologous donation reduces homologous transfusion requirements, but no such conclusion could be drawn from our data on acute normovolemic hemodilution. It seems particularly important to correct the presentation of our data because the other studies Goodnough et al. cite in their review had very low statistical power to show that there is no meaningful difference between preoperative autologous donation and acute normovolemic hemodilution. We recently summarized our position with regard to the comparison of preoperative autologous donation and acute normovolemic hemodilution.4

Arnulf Lorentz, M.D.
Thomas Frietsch, M.D.
Universitätsklinikum Mannheim, D-68167 Mannheim, Germany
arnulf.lorentz@anaes.ma.uni-heidelberg.de

4 References

1
Goodnough LT. Acute normovolemic hemodilution. (Accessed July 25, 2002, at http://www.nata-edu.org/Art3.htm.)

2
Lorentz A, Osswald PM, Schilling M, Jani L. A comparison of autologous transfusion procedures in hip surgery. Anaesthesist 1991;40:205-213
Web of Science | Medline

3
Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. N Engl J Med 1999;340:525-533
Full Text | Web of Science | Medline

4
Lorentz A, Frietsch T. Preoperative autologous deposit must be employed properly to utilize its potential. J Clin Anesth 2001;13:470-472
CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Goodnough replies:

To the Editor: The relative contributions of preoperative autologous blood donation and acute normovolemic hemodilution to blood conservation have been demonstrated to be similar, each generating the equivalent of 1 to 2 units of allogeneic blood.1,2 Controlled clinical trials directly comparing preoperative autologous donation and acute normovolemic hemodilution have generally confirmed this equivalency. Although the study by Lorentz et al.3 did show that allogeneic exposure was reduced in the group of patients who donated blood before surgery, as compared with the control group, and that no such conclusion could be drawn with respect to acute normovolemic hemodilution, a recent meta-analysis4 of five clinical trials directly comparing preoperative autologous donation with acute normovolemic hemodilution, including the study by Lorentz et al.,3 concluded that the two strategies did not differ (odds ratio, 1.05) in their effect on allogeneic blood transfusion outcomes.

Lawrence T. Goodnough, M.D.
Washington University School of Medicine, St. Louis, MO 63110-1093

4 References

1
Goodnough LT, Skikne B, Brugnara C. Erythropoietin, iron, and erythropoiesis. Blood 2000;96:823-833
Web of Science | Medline

2
Goodnough LT, Grishaber JE, Monk TG, Catalona WJ. Acute preoperative hemodilution in patients undergoing radical prostatectomy: a case study analysis of efficacy. Anesth Analg 1994;78:932-937
CrossRef | Web of Science | Medline

3
Lorentz A, Osswald PM, Schilling M, Jani L. A comparison of autologous transfusion procedures in hip surgery. Anaesthesist 1991;40:205-213
Web of Science | Medline

4
Vamvakas EC, Pineda AA. Autologous transfusion and other approaches to reduce allogeneic blood exposure. Best Pract Res Clin Haematol 2000;13:533-547
CrossRef | Web of Science

Citing Articles (1)