(S-182) Singbartl, G., Saturday 9:15

TITLE: EFFECTIVENESS OF PRE-OPERATIVE AUTOLOGOUS BLOOD DONATION (ABD) IN RHEUMATOID ARTHRITIS (RA) PATIENTS

AUTHORS: Guenter Singbartl, MD1, J Reibold, MD2, E Goudschaal, MD3, A Quoss, MD3
AFFILIATION: 1ENDO-Klinik Hamburg, Soltau, Germany; 2Klinik Dr. Guth, Hamburg, Germany; 3Rheumaklinik, Bad Bramstedt, Germany.

INTRODUCTION: Regarding ABD, RA-Pat. constitute a special group. They are known for undergoing repeated elective orthopedic surgery, making them ideal candidates for ABD, and for suffering from chronic anemia, at least questioning the efficacy of ABD. A systematical analysis about the efficacy of ABD in a sufficiently large number of RA-pat. has not been published so far.
METHODS: This study analyzed 199 RA-patients' records participating in an ABD-program (1 unit) prior to hip or knee arthroplasty. RA had been known for many years and diagnosed by clinical and laboratory criteria according to the American Rheumatism Association [1]. Pat. were eligible for ABD, if presenting with compensated organ function (if necessary with co-medication), if suitable for surgery (physical status was rated according to ASA-score); and if hb-value100 g/ltr. Blood vol. (BV) was calculated according to [2], systemic hb by venous hb*0.9, and increase in rbc mass (+rbc) by preop. rbc mass (in- vivo plus ex-vivo) minus init. rbc mass prior to ABD. Statistics included tests for normal distribution, t-test/U-test/Wilcoxon- test, ANOVA/Friedman-test, Chi2-test, SPEARMAN rank correlation, univariate regression analysis, and Bonferroni correction. Data are given as mean±SD. Statistical significance was set at p<0.05 (*).
RESULTS: Tab. 1 summarizes relevant data. Besides interval between donation and operation (IDOP) (F=9.82), both the patient's rbc mass init. (F=14.98) and rbc mass donated by ABD (F=5.62) were shown to have impact on +rbc, while neither age nor ASA-score had.

Tab. 1

all pat.

men

(52)

women

(147)

p

Age (yrs.)

59.4±15.1

55.7±18.3

60.6±13.6

*

BV (ltr.)

4.3±0.7

4.8±0.7

4.1±0.5

*

hctinit. (%)

33.6±3.9

33.7±5.0

33.6±3.5

ns

rbc massinit. (l)

1.5±0.4

1.63±0.4

1.45±0.4

*

IDOP (days)

18.3±12

17.6±11

18.6±12

ns

hct preop. (%)

30.7±4.0

31.1±4.8

30.6±3.7

ns

+rbc (ml)

51±82

45±97

53±76

ns

DISCUSSION:With respect to +rbc we show that a con- servative concept of 1-unit ABD is not very effective to increase total rbc mass in RA-Pat during ABD. To improve efficacy of ABD rbc mass donated should be increased, and IDOP should be extended up to at least 4 weeks.
REFERENCES:

1) Surgery 1962. 51:224-32.

2) Arthritis Rheumatism 1988. 31:315-24. (This study contains relevant data of E.G.'s MD-thesis).