21.  Should you type and cross your reductions or use autologous blood?  (Annals 1996; 37:585)

Answer:
Jack Cohen reviewed the number of patients receiving blood transfusions during or soon after reduction mammoplasty over a 5.5 year period.  Only 3 of 395 patients received a transfusion during that time period.  Of note, most of the operations were performed with the routine infiltration of 50 cc of 0.5% xylocaine with 1:200,000 adrenalin preoperatively.  He concluded that in otherwise healthy patients with a normal coagulation profile only a type and screen was necessary.  Though some surgeons have put forth that autologous blood transfusions may speed recovery, studies by Clugston (PRS 1995; 95:824) and Yu (PRS 1994; 94:328) have shown no benefit in terms of postoperative hemoglobin level, length of hospital stay, or cost.

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