Regulation of the Wilms'' tumour suppressor (WT1) gene by an antisense RNA: a link with genomic imprinting?

OBJECTIVE: To assess our experience with isolated iliac artery aneurysms and to assess the blood transfusion requirement in patients undergoing surgery for iliac artery aneurysms. MATERIAL AND METHODS: The case records of 12 patients who underwent 12 arterial reconstructive procedures for isolated iliac aneurysms from January 1989 to December 1995 were identified from our prospective vascular database and reviewed. Only patients with aneurysms limited to the common, external, or internal iliac arteries were included. RESULTS: Eleven patients had symptoms and rupture occurred in five patients. Aneurysmorrhaphy with graft interposition was the most common procedure. There was no perioperative mortality. The median transfusion requirement was 11 units per operation (range 1-30 units). The median intraoperative blood loss was 4700 ml (range < 500-13,000 ml). CONCLUSIONS: Isolated iliac aneurysm is a dangerous condition. A low perioperative mortality is possible only if large volumes of blood are available.     

Can radioactive iodine be used in the treatment of diffuse non-toxic goiter?

Traditional treatment modalities of diffuse nontoxic goitre are thyroid hormone suppression or surgery. When treating nodular nontoxic goitre with 131I treatment, a reduction in thyroid volume to about 50% is seen. In the present study we evaluated the effect of 131I treatment in 21 patients treated for a diffuse nontoxic goitre and followed by evaluation of thyroid volume measured by ultrasound. Thyroid volume declined in all patients from median of 66 ml (range 27-160 ml) to 21 ml (9-108 ml) over a year, a reduction of 62%. Three patients developed hypothyroidism in the follow-up period (14%), one of these had a temporary hyperthyroid fase. In conclusion, 131I treatment of diffuse nontoxic goitre reduces thyroid volume by approximately 60% within 12 months. Hypothyroidism developed in 14% during a limited follow-up period.     

Long-term effect of 131I therapy of multinodular non-toxic goiter

The aim of this study was to investigate the long term effect of 131I treatment on thyroid function and size in patients with non-toxic multinodular goitre. The subjects were 69 consecutive patients with multinodular non-toxic goitre selected for 131I treatment and followed for a minimum of 12 months. Outcome measures were standard thyroid function variables and ultrasonically determined thyroid volume before and after treatment. Fifty-nine patients were treated with a single dose of 131I, 12 with two doses, and one with four doses. In 45 patients treated with one dose who remained euthyroid the median thyroid volume was reduced from 73 (interquartile range 50-106) ml to 29 (interquartile range 23-48) ml at 24 months. The median reduction was 40 (22-48) ml, half of which occurred within three months. Patients treated with two doses as well as those developing hypo- or hyper-thyroidism also had a significant reduction in thyroid volume. Eleven patients developed hypothyroidism (cumulative five year risk 22%). Side effects were few. In conclusion we find that 131I treatment of multinodular non-toxic goitre is an attractive alternative to surgery.     

Red blood cell transfusions for total hip replacement in a regional hospital. A six-year analysis

To evaluate changes in the need for homologous blood and to assess the impact of autologous blood transfusion, red cell transfusions in unilateral total hip replacement surgery, performed electively in the period 1986-1991, were studied in a regional hospital. Transfusion data, perioperative blood loss and post-operative haemoglobin concentration of 495 patients were analysed. From 1986 to 1991, the percentage of patients not transfused with homologous blood increased from 18.5 to 45.5%. After the introduction of an autologous blood transfusion programme in 1987, 116 of 430 patients (27.0%) donated autologous blood. No increase in the percentage of autologous donors was observed during the study. Most common reasons for nonparticipation were the patient's age, doctors' underordering and logistic limitations. 81.9% of autologous donors had total hip replacement surgery without homologous transfusions. Mean blood loss reduced significantly from 1,373 +/- 781 ml in 1986 to 958 +/- 582 ml in 1991 (p < 0.001). Transfusion requirement in the nonautologous patients fell from 2.6 +/- 1.8 units in 1986 to 1.4 +/- 1.4 units per patient in 1989 and increased thereafter to 2.2 +/- 2.1 units in 1991 (p < 0.01) and showed a strong correlation with blood loss (r = 0.58; p < 0.001). No changes in postoperative haemoglobin concentration were observed throughout the study. In conclusion, collection of autologous blood is effective, albeit still underutilized, to reduce homologous blood requirement. The close correlation between blood loss and transfusion requirement accentuates the role of surgical practice in the reduction of homologous transfusions.     

Frontal sinus mucoceles causing proptosis--two case reports

BACKGROUND: Blood requirements for Head and Neck surgical procedures have not been studied carefully. In order to set up an autotransfusion program, the blood loss and transfusion requirements should be known precisely. METHODS: The blood bank database was used to determine which Head and Neck procedures required blood transfusion during the previous 5 years. A list of 10 transfusion-associated operations was established, the records of all patients who underwent these procedures during a 5-year period were reviewed, and average the blood loss and number of units transfused determined. RESULTS: All procedures were for cancer resection. The operations were classified in 3 groups according to their transfusion probability: high (> 80%), low (< 5%) and moderate. For the moderate transfusion group, age, preoperative hemoglobin, and past medical history of cardiac and pulmonary disease were associated with higher incidence of transfusion. An average delay of 3 weeks was found between the diagnosis and the actual surgery. CONCLUSION: The transfusion requirements of Head and Neck surgical procedures could be safely met by an autotransfusion protocol, given the average delay of 3 weeks between diagnosis and surgery.     

Lower homologous blood requirement in autologous blood donors after treatment with recombinant human erythropoietin

The risk of blood-borne diseases has substantially increased the use of autologous blood transfusion. Many autologous donors, however, still need homologous transfusions. To find out whether recombinant erythropoietin (rhEPO) reduces requirements for homologous blood transfusion, we carried out a randomised, controlled trial, in which patients were stratified according to blood volume. We studied 95 autologous blood donors undergoing elective hip surgery. 50 patients were randomly assigned 500 U/kg rhEPO subcutaneously twice a week for 3 weeks, and 45 patients received no treatment (control group). The patients each donated two units of blood before surgery. Only 5 (10%) rhEPO-treated patients received homologous transfusions compared with 16 (36%) controls (p < 0.01). rhEPO was most useful in patients with a blood volume below 4 L and an estimated blood loss below 2 L or with a blood volume of 4-5 L and blood loss of 1-2 L. Continued administration of rhEPO caused no further increase in reticulocyte counts after the fourth injection, which was accompanied by a pronounced depletion of storage iron. rhEPO treatment had no effect on renal function, platelet count, or blood pressure. Subcutaneous rhEPO is an effective and safe way to reduce exposure to homologous blood in autologous donors. Its use can be restricted to a subpopulation of autologous blood donors, which improves the cost-effectiveness of this expensive approach.     

Clinical and experimental studies of intraoperative autotransfusion using a new filtration device

The Haemocell S-350 device has recently been introduced for intraoperative autotransfusion. The system uses a novel membrane filter to process shed blood. In the first part of this study a 0.2-micron pore size filter was used in a randomized trial comparing the use of autotransfusion (n = 8) with bank blood controls (n = 9) during aortic reconstruction. This part of the trial was abandoned because of unexpected non-surgical bleeding. Bank blood requirements fell from a median of 3.0 (range 0.0-9.0) units to 1.5 (range 0.0-7.0) units when autotransfusion was used, but these patients had a greater perioperative blood loss (1791 (range 932-3104) versus 1140 (range 440-3840) ml). There was evidence of postoperative heparin excess with an activated partial thromboplastin time ratio of 1.3 (range 0.9-3.0) versus 1.0 (range 1.0-1.2) in controls and an activated clotting time of 206 (range 143-280) versus 137 (range 107-142) s. This was confirmed by raised plasma heparin levels and a prolonged thrombin time normalized by protamine. To improve performance a 0.6-micron pore size filter was studied in ten patients. Filtration efficiency doubled from 19 to 38 per cent. Electron micrographs demonstrated better filter clearance, but 44 per cent of the original concentration of heparin remained in the reinfusate. The S-350 device may be an attractive alternative to centrifugation for intraoperative autotransfusion but, until efficiency is improved, it should only be used for cardiovascular surgery when excess heparin can be reversed with protamine.     

Autologous blood transfusion for pulmonary and mediastinal surgery in 144 patients. The effectiveness of recombinant erythropoietin injection

Preserved autologous transfusions have been performed for elective pulmonary and mediastinal surgery to prevent the adverse effects of homologous transfusions. Autologous blood was collected preoperatively from 144 patients. The collected blood volume ranged from 400 to 1,600 ml with a mean volume of 544 ml. In four patients with benign diseases, 1,200 to 1,600 ml of blood was collected using 3,000 U of intravenous recombinant human erythropoietin (rh-EPO) administered every other day. One hundred twenty-three of these patients (85 percent) did not require a homologous transfusion. In the 84 patients undergoing either a pneumonectomy, lobectomy, or segmentectomy, 68 (81 percent) avoided homologous blood exposure. A patient with rh-EPO who bled 2,000 g during surgery received an autotransfusion of only 1,400 ml and his postoperative course was uneventful. Preserved autologous blood collected after rh-EPO injections is an effective method for minimizing homologous blood transfusions in pulmonary and mediastinal surgery.     

Intraoperative autotransfusion: equipment, protocols, and guidelines

Blood obtained by intraoperative autotransfusion is: 1) readily available 2) sterile 3) compatible 4) normothermic 5) inexpensive and may be infused rapidly for volume support. We have made extensive modifications to commercially available equipment in order to provide a safe, effective IAT. The effects of IAT in our series of 85 patients are outlined below. Red Cell Mass is reduced after IAT because of irretrievable blood loss and hemolysis, and may be controlled by homologous transfusion when necessary. Red Cell Survival is normal after IAT. Hemolysis. Plasma free hemoglobin is consistently elevated after IAT, but clears within 24 hours. Platelets are normal for patients autotransfused less than 3,500 ml; micropore filters should not be used in cases where greater than 3,500 ml blood is expected to be reinfused; in cases where greater than 3,500 ml is reinfused, 10 units of platelets are recommended for every 3,000 ml of blood reinfused; IAT does effect platelets function; however, platelets circulating within the patient function normally. Coagulation. We use local ACD to eliminate extracorporeal surface clotting. Even with massive IAT we have never demonstrated any clinical or laboratory evidence of intravascular coagulopathy. "Dilutional coagulopathy" may be procuced when greater than 5,000 ml are reinfused, and may be controlled with fresh frozen plasma and platelet concentrates. Bilirubin levels were normal after IAT despite gross hemoglobinuria. Fat emboli were not noted after IAT. Air emboli must be a concern in IAT; HOWEVER, PROPER OPERATION AND EQUIPMENT MODIFICATION MAY ELIMINATE EMBOLI. Renal Failure was not noted after IAT. Alveolar-arterial Oxygen Difference and Blood Gases were normal after IAT. We feel IAT is not necessary if a blood loss less than 1,000 ml is expected. Also, if greater than 3,500 ml is expected additional backup (i.e. homologous transfusions, platelets, fresh frozen plasma) may be required. As banked donor blood reserves become more limited, IAT may become a routine part of general surgical procedures.     

Self-healing juvenile cutaneous mucinosis in a patient with nephroblastoma

PURPOSE: Enhanced engraftment and reduced viral complications may be achieved in bone marrow transplantation (BMT) by limiting homologous transfusions. We report on limiting donor exposures before and after BMT in a newborn with severe combined immunodeficiency (SCID) using dedicated whole blood and plateletpheresis donors as well as a sterile connecting device (SCD). PATIENTS AND METHODS: A 1-day-old neonate was admitted for an allogeneic, human leukocyte antigen-disparate, T-cell-depleted BMT performed on day 43 of hospitalization. All transfused red blood cells (RBCs) and platelets were cytomegalovirus negative, and were irradiated and leukodepleted (via a Pall filter). Using the SCD, tubing above the filter was connected to the product bag, and the distal tubing was connected to a transfer pack for collection of the filtered product. Additional transfer packs were connected to the filtered product using the SCD to separate small aliquots as needed. RBC aliquots were irradiated individually before each transfusion. RESULTS: During a total of 134 days of hospitalization, only four donor exposures occurred. Eleven RBC transfusions (mean volume 46.4 +/- 12.6 ml) from three donors and five plateletpheresis transfusions (mean volume 74.2 +/- 7.5 ml) from one donor constituted all the patients' transfusion requirements. Evidence of engraftment was seen on day 18 post-BMT with an absolute neutrophil count sustained at > 500 cells/mm3. The last transfusion was received on day 35 post-BMT. CONCLUSIONS: Current blood transfusion technology enables patients undergoing bone marrow transplantation to have limited donor exposures. This practice should decrease viral complications without effecting bone marrow engraftment.     

Autotransfusion after coronary artery bypass grafting halves the number of patients needing blood transfusion

BACKGROUND: Several randomized studies about autotransfusion of shed mediastinal blood in patients undergoing coronary artery bypass grafting have resulted in divergent findings concerning reduction of the need for homologous blood transfusions. Most of these studies used less strict criteria for homologous blood transfusion than applied in daily clinical practice. METHODS: A prospective, randomized, controlled study involving 120 patients having elective, uncomplicated coronary artery bypass grafting was performed. The autotransfusion group received transfusion of shed mediastinal blood for 18 hours. Criteria for homologous blood transfusion were hemoglobin concentration less than 5.0 mmol/L in the intensive care unit and less than 5.5 mmol/L during the rest of the hospital stay. RESULTS: Twenty-eight percent of patients in the autotransfusion group received homologous blood transfusion versus 55% in the control group (p = 0.007). Ninety-five percent of the shed mediastinal blood was transfused. In the autotransfusion group, a total of 26 units of homologous blood was used versus 78 units in the control group (p < 0.001). CONCLUSIONS: Autotransfusion of shed mediastinal blood in patients undergoing elective, uncomplicated coronary artery bypass grafting halves the number of patients needing homologous blood and reduces the amount of homologous blood given.     

Prognostic indicators for toxic mastitis in dairy cows

OBJECTIVE: To measure serum thyrotropin (TSH), and free thyroxine concentrations in newborns delivered in areas with differing degrees of iodine deficiency, (prior to the salt iodization programme), and to use these biochemical indices to assess the current status of thyroid function in the group. DESIGN: Cross sectional. SETTING: Chemical Pathology, University of Zimbabwe, Medical School. Radio-immunoassay laboratory, Parirenyatwa Hospital. SUBJECTS: 500 healthy full term newborns, aged two to four days old, weighing not less than 2.5 kg. MAIN OUTCOME MEASURES: Thyroid hormone status of newborns. RESULTS: The mean serum FT4 level was found to be slightly but significantly different between the newborns from Harare region, (low goitre prevalent area), and Wedza district (moderate to severe goitre prevalent area). Although there was a trend in the distribution of TSH to higher values in the moderate to severe goitre prevalent areas, the differences were statistically non significant, p = 0.175. The median TSH value in the newborns was 4 microU/ml. TSH values were below 10 microU/ml in 90%, between 10.1 and 20 microU/ml in 9%, and between 20.1 and 32 microU/ml in 1% of the cases. No sex related differences were observed in either the TSH nor the FT4 values of the newborns. CONCLUSION: This study demonstrates that the iodine supplementation programme has been successful, but further monitoring is necessary to ensure complete supplementation throughout the country and to guard against hyperthyroidism which is known to occur during iodine supplementation programmes.     

Prevalence of IgG and IgM anti-Toxoplasma antibodies in patients with HIV and acquired immunodeficiency syndrome (AIDS)

OBJECTIVE/STUDY DESIGN: After blood loss, production of erythropoietin in adults increases, which accelerates erythropoiesis and restores the erythroid mass. It is unclear whether preterm infants with large phlebotomy losses have a similar response. We therefore measured serum erythropoietin concentrations in 11 ill preterm infants (1057 +/- 167 gm) as their phlebotomy losses accumulated. RESULTS: Before the first transfusion, erythropoietin concentrations were 68.9 +/- 36.2 mU/ml (range 0 to 205 mU/ml) at 5 ml/kg blood out, 17.4 +/- 8.9 mU/ml at 10 ml/kg, and 4.8 +/- 2.6 mU/ml at 15 ml/kg. Erythropoietin concentrations did not increase in any patients despite increasing phlebotomy losses. CONCLUSION: Serum erythropoietin concentrations in ill preterm infants do not increase in the face of significant blood loss. Although the mechanistic explanation for this failure is unclear, it likely contributes to the transfusion requirements of this population.     

Giving both enoxaparin and dextran increases the need for transfusion in revision hip arthroplasty

OBJECTIVE: To find out if the need for transfusion was increased by volume substitution with dextran 70 in patients receiving prophylaxis against thrombosis with low molecular weight heparin. DESIGN: Open randomised controlled trial. SETTING: University hospital, Sweden. SUBJECTS: 40 patients undergoing revision hip arthroplasty. INTERVENTIONS: Enoxaparin 40 mg was given daily. Intraoperative normovolaemia was maintained with albumin (n = 20) or dextran 70 (n = 20). Intraoperative autotransfusion was used. Packed cell volume was kept above 0.29, if necessary with homologous blood. MAIN OUTCOME MEASURES: External blood loss, red cell balance. RESULTS: Dextran patients received 0.64 (0.2) g/kg of dextran (mean (SD)) and required more (p < 0.05) homologous blood (3.8 (2.4) units) than those receiving albumin (2.3 (1.6) units). The initial and final packed cell volumes were similar (0.40 and 0.32 compared with 0.41 and 0.32, respectively). The calculated loss of red cells was larger in the dextran group (1401 (511) compared with 1077 (374); p < 0.05). CONCLUSION: The combination of enoxaparin and dextran appreciably increased the need for transfusion compared with enoxaparin alone.     

Fat elimination during intraoperative autotransfusion: an in vitro investigation

Intraoperative autotransfusion of scavenged blood is an established method to reduce the need for perioperative homologous blood transfusion. However, if fat particles contaminate blood suctioned from the wound site, no reliable method is available to remove them during the washing and concentration of the recycled blood. A new generation of autotransfusion devices (e.g., continuous autotransfusion system [CATS]), based on separation chambers used in cell separators or plasmapheresis devices, allows continuous procession of the collected blood, in contrast with the discontinuous process used in conventional autotransfusion devices such as the Cell Saver 5. Theoretically, the continuous system should be more efficient than the discontinuous system in eliminating fat. Outdated, 36-day-old packed red blood cells, 600 mL, were mixed with 500 mL of lactated Ringer's solution and 200 mL of soya oil. Soya oil was used because it has a fatty acid composition similar to that of fat found in bone marrow. The blood mixture was then washed and concentrated by using either the CATS or the Cell Saver 5. Six samples were processed by each device. The CATS eliminated the soya oil (200 mL) completely, whereas the Cell Saver 5 delivered 30.3 +/- 7.8 mL soya oil into the retransfusion bag. The new generation of autotransfusion devices allows complete removal of fat particles. IMPLICATIONS: Autotransfusion devices serve to wash and retransfuse blood scavenged from the wound site. However, they cannot completely remove fat particles. This in vitro investigation showed that a new device completely removes fat particles and thus prevents retransfusion of fat.     

Shed blood autotransfusion influences ischemia-sensitive laboratory parameters after coronary operations

The diagnostic significance of ischemia-sensitive laboratory parameters in respect to possible interference with shed blood autotransfusion was assessed in a prospective study with 100 patients undergoing elective coronary artery bypass grafting. Serum levels of creatine kinase, creatine kinase MB activity, creatine kinase MB mass concentration, 2-hydroxybutyrate dehydrogenase, lactate dehydrogenase-1, troponin-T, myoglobin, and glutamicoxaloacetic transaminase were repeatedly assessed up to the sixth postoperative day. Thirty-seven patients were excluded from the study due to postoperative development of myocardial infarction (n = 4), transient ischemic events (n = 25), and left bundle-branch blocks (n = 8). In the remaining group of 63, 37 patients were retransfused with 580 +/- 370 mL shed blood up to the twelfth postoperative hour, and 26 patients did not receive autotransfusion due to minimal mediastinal blood loss. The results of our study show that the ischemia-sensitive laboratory parameters were significantly influenced by shed blood autotransfusion: 8 hours postoperatively, creatine kinase (272%), creatine kinase MB fraction (151%), 2-hydroxybutyrate dehydrogenase (130%), lactate dehydrogenase-1 (133%), troponin-T (200%), myoglobin (159%) and glutamic-oxaloacetic transaminase levels (153%) were significantly elevated (p < 0.05) in patients with postoperative autotransfusion, although there were no electrocardiographic signs of myocardial ischemia in this group of patients. Our study shows that postoperative autotransfusion of mediastinal shed blood may interfere with the diagnosis of perioperative myocardial ischemia by laboratory parameters in coronary bypass patients.     

Blood components: indication and notice of transfusion

The total number of blood donors in 1996 was 6 millions, and the number of 200 ml whole blood donors was 2.16 million(35.7%), whereas the numbers of 400 ml and apheresis donors were 2.66 million(44.1%), and 1.22 million(20.2%) respectively. From the donated blood, about 18.78 million units(1u: equivalent to 200 ml WB derived) of blood components were prepared and used for blood transfusion. Currently, whole blood is separated and prepared into MAP red cell concentrates and FFP, and all platelet concentrates are prepared from apheresis donations. In 1996, MAP red cell concentrates occupied 30.5% of all blood supply for transfusion, whereas FFP occupied 27.7% and PC occupied 40.2%.     

Objective and subjective quality of life of first-admitted women and men with schizophrenia

There have been assessed physical and ultrasonographic examination in patients with mastopathy and concentration of prolactin, thyrotropin, thyroxine in blood serum of these patients. The examination was carried out in 65 patients with mastopathy (group M), at the age ranging from 18 to 53 years, and in 30 healthy women (group K), at the age from 18 to 55 years as a reference group. The group of the patients with mastopathy and the control group were divided into three subgroups (taking into account the age and function of ovaries). There were excluded from the examined group patients whose general health state, particularly endocrinological disease, and applied drugs might condition occurrence of pathological changes in mammary glands. Particular attention was paid to exclusion from examination of patients with both primary and secondary hyperprolactinemia. Non-toxic goitre was found in 80% patients with mastopathy, and the results of palpation examination of thyroid were confirmed by thyroid ultrasonographic examination. Non-toxic goitre was significantly more often in patients with mastopathy in comparison with healthy women, and there was found significantly higher thyroid volume in these patients. The hormonal evaluation showed first of all significantly higher mean concentration of prolactin in blood serum of the patients with mastopathy than in the blood serum of healthy women in comparison with both the whole examined group and subgroups. There were not significant differences between the mean concentration of thyrotropic hormone, triiodothyronine and thyroxine in blood serum in premenopausal patients with mastopathy and mean concentration of these hormones in healthy women. Only postmenopausal patients were characterized by significantly lower mean concentration of triiodothyronine in comparison with the healthy subgroup. CONCLUSIONS: 1. In patients with mastopathy, there often coexists enlargement of thyroid gland, and prolactin may be also considered as an agent which influences genesis of a goitre. 2. It should be thus admitted that hormonal examinations with particular consideration to prolactin and thyroid hormones are appropriate management in diagnosing and treatment of patients with mastopathy.     

Effect of blood transfusion on survival after esophagogastrectomy for carcinoma

BACKGROUND: There is growing evidence that blood transfusion is associated with clinical factors that can lead to transfusion-induced immunosuppression. This effect can be beneficial or deleterious. METHODS: The effect of perioperative allogeneic blood transfusion on survival was studied retrospectively in 524 patients who were discharged from the hospital after esophagogastrectomy for carcinoma performed in a single unit over a 10-year period. RESULTS: The median operative blood loss for the series was 500 mL (range, 50 to 3,750 mL). Three hundred thirty-five patients (64%) received a perioperative allogeneic blood transfusion related to esophagogastrectomy, and 189 (36%) did not. The median perioperative blood transfusion administered was 900 mL (range, 300 to 12,950 mL). Perioperative allogeneic blood transfusion was associated with reduced survival for patients in stage III (p < 0.05) at 1 year, but no significant difference was found in this stage at 3 or 5 years after resection. Stage III disease accounted for 250 (48%) of the 524 patients discharged. CONCLUSIONS: Although perioperative allogeneic blood transfusion does not affect long-term survival after esophagogastrectomy for carcinoma, it does have a significant association with short-term survival in a group whose overall survival is often limited after resection. Attention should be directed toward minimizing operative blood loss and transfusing only for factors known to be clinically important, such as oxygen delivery and hemodynamics, not arbitrary hemoglobin levels.     

Immunization with the N-terminal region of the nonstructural protein NS1 promotes survival after challenge with lethal influenza A virus dose

We investigated the utilization patterns of autologous blood donation for radical retropubic prostatectomy (RRP) during a 6-year period. A total of 225 patients electing RRP with blood donation were identified for analysis. Group 1 consisted of 113 men who had an RRP from 1990 to 1993. Group 2 consisted of 112 men who had an RRP from 1993 to 1995. Charts were reviewed for the number of units transfused, number of autologous units donated, and operative blood loss. More patients autodonated blood in the later group (84% vs. 75%). Technical improvements and experience have significantly decreased blood loss and the need for transfusions (69% vs. 96% in the early group). In the more current series, only 14% of patients who autodonated blood required homologous transfusion vs. 42% in the earlier group. An increase in the amount of wasted blood (42% vs. 16% in the early group) also was noted. The 4-unit donors had the lowest homologous transfusion rate in both series (group 1 = 21%, group 2 = 5%); the 2-unit donors had the lowest units wasted per person (0.74). In addition, the 2-unit donors maintained a low homologous transfusion rate of 16%. These data suggest that 2 units of autologous blood donation has a reduced risk of homologous blood transfusion while the amount of autologous blood wasted is minimized.