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indications to the reinfusion of salvaged blood (bacterial contamination,
malignancy, and sickle hemoglobin) and complications of
the procedure itself such as air embolism, nephrotoxicity, and coagulation
disorders (7).
The limitations of these meta-analyses should be acknowledged.
Firstly, the sample sizes of most of the studies included in these
meta-analyses were small. Except for the meta-analysis of aprotinin
in cardiac patients, which included 5808 patients, all of the other
meta-analyses included less than 1000 patients. Meta-analyses of
other interventions, containing more patients than were included in
most of the meta-analyses in this study, have still reached false conclusions
about efficacy when their results were compared with subsequent
“definitive” large trials (203). Thus, the results of this metaanalysis
must be interpreted with caution, especially the subgroup
analyses (e.g. the efficacy of desmopressin in patients receiving aspirin).
Secondly, there was unexplained heterogeneity in the meta-analysis
of ANH – and to some extent also in the meta-analysis of autotransfusion/CS
– which makes the results difficult to interpret.
Thirdly, the frequency of post-operative myocardial infarction, the
need for re-operation because of bleeding, and side-effects were not
reported in all studies. This supports the belief of others that uniform
and comprehensive standards are needed when reporting the results
of these studies (204).
The results of these meta-analyses suggest that further large randomized
trials using clear transfusion guidelines need to be done.
Questions of particular interest include comparison of high and low
doses of aprotinin, determining whether ANH is efficacious, establishing
whether desmopressin truly is efficacious in cardiac patients
on aspirin, and direct comparison of these technologies with each
other and with “optimal clinical management”.
Australian follow-up anlyses: The analyses of the Australian update
differed from the ISPOT-analyses by including a few trials from additional
specialties. All in all the ISPOT-analyses and the Australian
analyses seem to corroborate one another.
The update gave additional information: Firstly, it is notable (due to
the update and the ISPOT-results) that for several interventions there
was a general tendency towards a decrease in the efficacy of the technology
when a transfusion protocol was used. Secondly, the overall
reductions of allogeneic blood transfused were modest, ranging from
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