Plakhotina E NVidnovsky Perinatal Center, Russian Federation
Title: Efficacy of volumetric preoperative autoplasma donation in the surgical treatment of PAS-disorders
Bloodloss in the surgical treatment of PAS-disorders is from 500 to 20,000 ml. Up to 90% of patients require transfusion of donor blood components. Given the high risk of complications from donor blood transfusion, we need safe methods of replenishing blood loss. The aim of the study is to improve the results of treatment of patients with PAS-disorders during organ-preserving surgeries and to determine the optimal volume of preoperative autoplasma preparation.
78 patients diagnosed with PAS were randomized into 3 groups. Group No. 1 - 23 patients, with a preoperative preparation of 500-1000 ml of autoplasma. Group No. 2 - 36 patients, collected 1500-2000 ml of autoplasma. Group No. 3 - 19 patients without autoplasma preparation (control). Autoplasmic plasmapheresis was performed from 27 to 35 weeks of gestation by the method of membrane plasmapheresis with an interval between sessions of at least 7 days. In one session, 500 ml of autoplasma was prepared. The analysis of the volume of blood loss, the volume of infusion-transfusion therapy, laboratory parameters, complications was carried out. The reliability of the results obtained is achieved by calculating the sample size, distribution by groups by generating random numbers in Microsoft Office Excel, mathematical processing of the material by nonparametric methods; the significance level was accepted as 0.05.
The study groups were comparable in terms of blood loss. Group No. 2 had significantly fewer donor plasma transfusions compared to groups No. 1 and No. 3. There were no differences in donor plasma transfusions between groups No. 1 and No. 3. Preparation of autoplasma before surgery significantly reduced the risk of donor plasma transfusion in group No. 2. Despite the absence of differences in the volume of blood loss, reinfusion and transfusion of donor erythrocytes, at discharge from the hospital, the hemoglobin concentration was lower in group No. 2, which may be associated with the accumulation of iron deficiency in pregnant women. One patient in group No.3 (control) developed TRALI syndrome.
Preoperative preparation of autoplasma with a volume of 1500-2000 ml significantly reduces the volume and risk of transfusion of donor FFP during organ-preserving surgery in patients with PAS-disorders. Avoids transfusion of donor plasma in 75% of cases. Volumetric preoperative preparation of autoplasma in pregnant women requires monitoring of iron concentration and its correction before surgery.
To be updated