[Hemodilution and peroperative autotransfusion during harvest for bone marrow graft]

Abstract

In order to avoid the infectious and immunological complications of homologous blood given to autologous bone marrow graft recipients, intraoperative haemodilution together with delayed salvage of the red blood cells contaminating the marrow graft were used prospectively over a period of 6 months. This was carried out in 74 patients, i.e. 2 allogenic and 72 autologous donors (mean age 27.2 +/- 19.7 years). A mean of 13.66 +/- 7.10 ml.kg-1 bone marrow were harvested. Fluid replacement was carried out, volume for volume, with a modified fluid gelatin (Plasmion) (n = 73; 14.6 +/- 6.6 ml.kg-1), glucose 5% (n = 54; 9.64 +/- 4.88 ml.kg-1) and Ringer solution (n = 33; 8.1 +/- 3.3 ml.kg-1). No haemodynamic problems occurred. Autologous blood transfusion was possible in 54 patients; mean volume of bone marrow harvested was 631 +/- 298 ml, and a mean of 293 +/- 154 ml of blood was retransfused to the patients (mean haematocrit of the blood units: 0.536 +/- 0.048). Nine of these patients were also given homologous blood. In the other 20, the volume of bone harvested marrow was significantly lower than in the autologous transfusion group (430 +/- 202 ml; p less than 0.05), and red blood cell salvage was not possible; only 3 patients received homologous blood. Finally only 16.2% of the patients in this series were given homologous blood. It is concluded that intentional isovolaemic haemodilution together with autotransfusion of salvaged blood can reduce the need for homologous blood during bone marrow harvesting.