Molecular biology technology in intraoperative autologous transfusion during radical prostatectomy

A recognized complication of radical prostatectomy is blood loss and transfusion with its attendant risks. To obviate this, many urologists have suggested the use of autologous blood donation, usually consisting of two units prior to surgery. Since this may be costly and may not meet the blood loss needs of all prostatectomies, intraoperative autologous transfusion (IAT) may be a viable alternative. We utilized the cell saver for IAT during the last 20 radical prostatectomies, then compared them to the previous 20 proctectomies, prior to which same patients donated 2 autologous units of blood. In the IAT group, only 1 patient received allogeneic blood. In the autotransfusion group, 6 patients needed both autologous and allogeneic transfusions. One concern with IAT was that there may be viable cancer cells in the blood transfused back to the patient. To investigate this, samples were taken from the peripheral blood, from blood aspirated from the operative site, and from the blood processed by the cell saver. The mRNA was extracted and assayed by reverse transcriptase polymerase chain reaction (PCR) for prostate specific antigen (PSA) using both outer and inner primers. The samples were then assayed by Southern blot analysis. The PSA mRNA was highest in the blood aspirated from the operative site and less in the autotransfused blood. PCR showed no PSA mRNA in the autotransfused blood, where the aspirated blood was sequestered to separate components. The peripheral blood mRNA varied with the serum PSA value. Intraoperative autologous transfusion is cost-effective and reduced the need for homologous transfusion. Furthermore, the likelihood that PCA cells are being transfused is negligible, when compared to that found in the peripheral blood.