Preoperative autologous blood donation in orthognathic surgery: a follow-up study of 179 patients.
Puelacher W. Hinteregger G. Nussbaumer W. Braito I. Waldhart E.
Department of Oral and Maxillofacial Surgery, Leopold-Franzens-University Clinic, Innsbruck, Austria.
Although there have been recent advances in maxillofacial surgery and anaesthetic techniques, blood replacement is still common in orthognathic surgery. 179 patients underwent elective orthognathic surgery and donated autologous blood preoperatively. Standardized questionnaires about the preoperative blood donation were distributed to the patients. Haemoglobin, haematocrit, red blood cells and platelets were measured before blood donation, presurgically and postsurgically, as well as one year after surgery. Nearly all patients (98%) would recommend preoperative autologous blood donation. 97% of the patients saw the benefits of autologous blood donation in avoiding transfusion-transmitted infectious diseases such as acquired immune deficiency syndrome (AIDS) and hepatitis. No serious side-effects have been observed after blood donation. In patients with bimaxillary osteotomies (65% of the predeposited autologous blood units) 41% were in cases having upper jaw osteotomies and only 22% of the preoperatively donated units were retransfused in patients having lower jaw osteotomies. After a postsurgical decrease, the mean haemoglobin and mean haematocrit levels regained the levels determined prior to the donation. Preoperative autologous blood donation of 2 to 3 units (900-1350 ml +/- 10%) of blood is recommended in bimaxillary osteotomies and 1 to 2 units (450-900 ml +/- 10%) of blood for upper jaw osteotomies. In lower jaw surgery, the acute isovolaemic haemodilution should be considered.