The use of autologous blood in the surgical treatment of spinal disorders.

A program of autologous blood transfusion in 101 patients who underwent spinal surgery was analyzed. Autologous transfusion was achieved by intraoperative blood salvage using a cell saver and with predeposited blood. The techniques of predeposition of blood included freezing the blood and using a storage solution. Forty-eight patients had scoliosis and received mainly cryopreserved autologous blood and 53 patients had other spinal diseases. Surgery was performed using only autologous blood transfusion in more than 90% of all patients cases. The program was well tolerated by the patients and easily managed by the blood center staff. There were no severe complications associated with this program. The use of instrumentation and extensive spinal fusion were found to be factors associated with increased intraoperative blood loss. This finding suggests that instrumentation surgery and extensive spinal fusion are indications for autologous blood transfusion. Cryopreserved autologous blood transfusion is an effective method for storing a sufficient volume of blood for scoliosis surgery without affecting the patients' preoperative hemodynamic status.     

Effects of cell saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on- versus off-cardiopulmonary bypass: a randomised trial.

OBJECTIVE: Off-pump CABG is potentially associated with reduced intraoperative blood loss and homologous blood transfusion in comparison to on-pump CABG. In this randomised controlled study we investigated the effects of autologous cell saver blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing CABG on- versus off-CPB. METHODS: Eighty patients were randomised into one of four groups: (A) on-CPB with cell saver blood transfusion (CSBT), (B) on-CPB without CSBT, (C) off-pump with CSBT and (D) off-pump without CSBT. Volume of intraoperative autologous blood transfusion, postoperative mediastinal blood loss and homologous blood transfusion requirements were measured. Homologous blood was transfused when haemoglobin concentration fell below 8 g/dl postoperatively. Pre- and postoperatively prothrombin time and partial thromboplastin time were measured. RESULTS: Preoperative patient characteristics were well matched among the four groups. The amount of salvaged mediastinal blood available for autologous transfusion was significantly higher in the on-pump group (A) compared to the off-CPB group (C) (433+/-155 ml vs 271+/-144 ml, P=0.001). Volume of homologous blood transfusion was significantly higher in group B vs groups A, C and D (595+/-438 ml vs 179+/-214, 141+/-183 and 230+/-240 ml, respectively, P<0.005). The cell saver groups (A and C) received significantly less homologous blood than the groups without cell saver (160+/-197 ml vs 413+/-394 ml, respectively, P<0.005). Patients undergoing off-CPB surgery received significantly less homologous blood than those undergoing on-CPB CABG irrespective of cell saver blood transfusion (184+/-214 ml vs 382+/-397 ml, P<0.05). Postoperative blood loss was similar in the four groups (842+/-276, 1023+/-291, 869+/-286 and 903+/-315 ml in groups A to D, respectively, P>0.05). Clotting test results revealed no significant difference between the groups. There was no significant difference in postoperative morbidity between groups. CONCLUSION: Off-pump CABG is associated with significant reduction in intraoperative mediastinal blood loss and homologous transfusion requirements. Autologous transfusion of salvaged washed mediastinal blood reduced homologous transfusion significantly in the on-CPB group. Cell saver caused no significant adverse impact on coagulation parameters in on- or off-CPB CABG. Postoperative morbidity and blood loss were not affected by the use of CPB or autologous blood transfusion. We recommend the use of autologous blood transfusion in both on- and off-pump CABG surgery.     

Use of autologous blood in total hip replacement. A comprehensive program

We evaluated the effectiveness of a comprehensive program for the use of autologous blood in reduction of the need for transfusion of homologous blood in total hip replacement in a prospective study of a consecutive series of patients. Transfusion of homologous blood was minimized through transfusion of preoperatively deposited autologous blood, intraoperative and postoperative salvage of washed red blood cells, and use of the clinical condition of the patient as the sole criterion for transfusion of non-autologous blood, regardless of the hematocrit. The cases of 143 patients who had had 154 primary total hip replacements were studied. One hundred and forty-three procedures were done on patients who had not been prevented from donating blood for medical reasons, and 93 per cent of these 143 procedures were performed with the availability of one to five units of preoperatively deposited autologous blood. The patients predeposited an average of 2.6 units of blood for each procedure. Ninety-two per cent of the procedures for which autologous blood had been predeposited were performed without transfusion of homologous blood. In the entire group of patients, almost 90 per cent of the transfused blood was autologous blood. Intraoperative salvage of red blood cells was successful in 148 procedures, and salvage was continued in the recovery room for all of these patients. An average of 408 milliliters of red blood cells was saved and reinfused, and this was 28 per cent of the average total loss of blood (1435 milliliters) for this series of procedures.(ABSTRACT TRUNCATED AT 250 WORDS)     

血液回收机应用于脊柱侧凸矫形手术的研究进展

背景 目前使用血液回收机进行自体血回收-回输作为一种血液保护策略已广泛应用于临床,以期减少术中同种异体血的输入量. 目的 回顾总结脊柱侧凸矫形手术使用血液回收机进行自体血回收-回输的研究新进展. 内容 从工作原理、临床价值、效能、经济效益、并发症等五个方面总结脊柱侧凸矫形手术使用血液回收机进行自体血回收-回输的研究进展. 趋向 需要进行大样本、多中心、前瞻性、随机对照试验进一步明确脊柱侧凸矫形手术使用血液回收机进行自体血回收-回输的效能及经济效益.     

Autologous blood transfusions in children and young adults with low body weight undergoing spinal surgery

The perioperative course of 118 patients weighing less than 45.5 kg (100.1 pounds) who participated in a predeposited autologous blood program from 1979-1984 is reviewed. Average age was 13 years 11 months (range 6 years 4 months to 20 years 4 months) and the average weight, 41 kg (range 30-45.4 kg). All underwent spinal surgery, 96% for scoliosis. The program involved preoperative donation of blood that was stored and subsequently retransfused to replace operative blood losses. Patients donated an average of 811 ml (range 208-1,320 ml) blood. Operation and hospitalization were completed by 63% without receiving any homologous blood, and the need for donor blood was reduced in the remaining 37%. Preoperative blood donation and retransfusion led to no significant complications. We describe an autologous blood transfusion program and show that autotransfusion is a safe and preferred method of blood replacement for children and young adults with low body weight undergoing elective surgery.     

Intraoperative autologous transfusion in children undergoing spinal surgery

An intraoperative autologous transfusion program was used in conjunction with preoperative phlebotomy in 25 children undergoing elective spinal surgery. Operative red blood cells, 10,000 ml, with an average hematocrit of 55%, as well as 7,300 ml of preoperative phlebotomy blood were returned to the patients. No complications were noted. The complete blood count on discharge was satisfactory, and the clotting parameters were unchanged. The results of this study show that intraoperative autologous transfusion with preoperative phlebotomy is safe, easy to perform, and cost-effective in children undergoing elective spinal surgery. The risks of homologous blood transfusions were eliminated.     

Autologous transfusion in acetabuloplasty in children

There were 22 patients with cerebral palsy aged six to 17 years who underwent an acetabuloplasty as part of an open reduction of the hip. In 11 patients a paediatric cell saver was used to collect autologous blood which was re-infused per-operatively. This group was compared to a cohort of 11 patients undergoing similar operations in whom only banked homologous blood was transfused. On average, 432 ml of autologous blood was reinfused compared to 909 ml of homologous blood (p < 0.01), representing 19.6% and 47% of the total blood volume, respectively (p < 0.002). Two units of homologous blood were transfused in the cell saver group compared with 20 units in the control group (p < 0.001). When using a paediatric cell saver, homologous blood transfusion was avoided in 82% of patients and there were no complications.     

Transfusions in patients undergoing cardiac surgery with autologous blood

PURPOSE: Determinants of allogeneic blood use in cardiac surgery include preoperative factors such as female sex, age, body weight, hematocrit and red cell volume. We verified if these variables also predicted the need for allogeneic transfusions when autologous blood is predonated. METHODS: Demographic and intraoperative variables, hemoglobin concentrations and transfusion requirements in patients undergoing cardiopulmonary bypass with autologous blood predonation were reviewed. Multivariate logistic regression and RECPAM tree-growing analyses were applied to identify the preoperative predictors of allogeneic transfusion in these patients. RESULTS: Data from 230 patients included in our autologous blood program between 1995 and 1998 were analysed. Patients undergoing complex/reoperative surgical procedures and patients over age 64yr with a low red cell volume (<2070ml) undergoing simple procedures were more likely to require allogeneic red cells. Younger patients with a low red cell volume undergoing simple procedures carried an intermediate risk. Allogeneic transfusion was avoided in 95% of patients undergoing simple procedures when red cell volume > or = 2070ml. CONCLUSIONS: In our institution, complex/reoperative surgery, low red cell volume and increased age are the main factors associated with the need for allogeneic red cell transfusion despite autologous blood predonation. Knowledge of the factors that limit the effectiveness of predonation with respect to allogeneic blood exposure should help clinicians decide which cardiac surgical patients should be included in autologous blood programs.     

The results of intraoperative autotransfusion in orthopaedic surgery

Perioperative hemorrhage associated with major orthopaedic surgery can become life threatening. Homologous bank blood transfusion can replace the volume of blood lost but it has serious disadvantages such as the transmission of viral agents, it has an insufficient platelet count, and transfusion reactions are possible. Hypotensive anesthesia, predeposited autologous blood transfusion and intraoperative autotransfusion are used to reduce these disadvantages. This study evaluates the results of 700 patients who underwent major orthopaedic intervention in our clinic between June 1991 and April 1998. Ninety-nine patients had hip surgery while 601 patients had spinal surgery. The autotransfusion unit saved an average of 858.9 +/- 136.8 cc of blood and an average of 1.9 +/- 1.2 units of saved blood was transfused. None of these patients needed homologous blood transfusion. One hundred patients who had spinal surgery during the same period were used as a control group. The control group required an average of 3.2 +/- 2.1 units of bank blood. Preoperative and postoperative hematocrit values revealed a statistically significant difference between the autotransfusion group and the homologous transfusion group (p < 0.05). The results of this study suggest that intraoperative autotransfusion prevents the decrease in hematocrit values while reducing the need for bank blood transfusion and hence avoiding the risk of transmission of viral infections.     

Intraoperative autotransfusion in primary hip arthroplasty: A randomized comparison with homologous blood

To study the quality and effect of blood produced by the cell saver compared with homologous blood in total hip arthroplasty, 40 patients were randomly divided into two groups. One group received autologous blood using the cell saver, whereas the second group served as a control, and received homologous bank blood. Hematologic and coagulation parameters of the patients were assessed both preoperatively and postoperatively. Samples from the autologous and the homologous blood were obtained before reinfusion, and were assessed as regards hematologic and biochemical parameters. The autologous blood satisfied all the intraoperative transfusion requirements of the autologous group and 75 percent of the total transfusion requirements. The operative and postoperative blood losses—hence, the total blood loss-were less in the autologous than in the control group. The autologous blood had a high hemoglobin, white blood cell, and plasma hemoglobin content and MCV compared with the homologous blood. Postoperatively, there were no differences as regards the hematologic parameters studied. There was no evidence of intravascular hemolysis in the autologous group. Postoperatively, in both groups, AT Ill, plasminogen, and protein C decreased. Other coagulation parameters were within normal limits in both groups. Intraoperative autotransfusion is safe and effective, and should be considered in hip arthroplasty to reduce the risks associated with homologous blood transfusion.     

Intraoperative autotransfusion in primary hip arthroplasty. A randomized comparison with homologous blood.

To study the quality and effect of blood produced by the cell saver compared with homologous blood in total hip arthroplasty, 40 patients were randomly divided into two groups. One group received autologous blood using the cell saver, whereas the second group served as a control, and received homologous bank blood. Hematologic and coagulation parameters of the patients were assessed both preoperatively and postoperatively. Samples from the autologous and the homologous blood were obtained before reinfusion, and were assessed as regards hematologic and biochemical parameters. The autologous blood satisfied all the intraoperative transfusion requirements of the autologous group and 75 percent of the total transfusion requirements. The operative and postoperative blood losses--hence, the total blood loss--were less in the autologous than in the control group. The autologous blood had a high hemoglobin, white blood cell, and plasma hemoglobin content and MCV compared with the homologous blood. Postoperatively, there were no differences as regards the hematologic parameters studied. There was no evidence of intravascular hemolysis in the autologous group. Postoperatively, in both groups, AT III, plasminogen, and protein C decreased. Other coagulation parameters were within normal limits in both groups. Intraoperative autotransfusion is safe and effective, and should be considered in hip arthroplasty to reduce the risks associated with homologous blood transfusion.     

Autologous blood transfusion in urology

In a total of 67 urological patients (24 transurethral resections of the prostate, 30 transvesical resections of the prostate and 13 radical prostatectomies) the blood lost during the operation was collected by using the Haemonetics cell saver, washed and cleaned of cells, haemoglobin and plasma haemoglobin and retransfused to the patients in the form of erythrocyte concentrate. When patients lose a large volume of blood, the lost plasma volume and the lost clotting factors must be substituted: in addition to electrolyte and colloidal solutions we use autologous fresh frozen plasma (FFP). Preoperatively we usually obtain FFP from the patient by plasmapheresis. All patients have tolerated the preoperative plasmapheresis very well and also the subsequent retransfusion of the intraoperatively saved autologous blood. Only 1 patient (who unexpectedly suffered a postoperative haemorrhage) received homologous blood; in other cases no homologous transfusion became necessary despite blood losses of up to 4500 ml.     

Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system: a retrospective comparison

This study investigates efficacy and safety of routine cell salvage system use in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion surgery with segmental spinal instrumentation. Forty-five consecutive adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by two surgeons at a single hospital were studied. Intraoperative cell salvage system was used in 23 patients, and the control group was 22 patients who underwent surgery without cell salvage system. The cell salvage system was the Haemonetics Cell Saver 5. The primary outcome measures were intraoperative and perioperative allogeneic transfusion rate, difference between preoperative and discharge Hg and Hct levels. Average patient age was 14.65 ± 1.49 in cell saver group and 13.86 ± 2.0 in control group. In cell saver group, average intraoperative autotransfusion was 382.1 ± 175 ml. Average perioperative allogeneic blood transfusion need was 1.04 ± 0.7 unit in cell saver group and 2.5 ± 1.14 unit in control group. No transfusion reactions occurred in either group. Average hemoglobin level in cell saver group was 10.7 ± 0.86 and average hemoglobin level in control group was 10.7 ± 0.82 on discharge. Cell saver reduces perioperative transfusion rate in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.     

术中自体血回收对红细胞免疫功能及其免疫受体的影响

目的 自体血回收对红细胞的免疫功能及其膜表面免疫受体的数量的影响.方法 随机选择全髂关节或股骨头置换的择期手术患者16例,术中取术野血和回收血各5 ml,测定红细胞C50>b受体花环率(RCR)和红细胞免疫复合物花环率(RCIR),以及红细胞表面CD35和CD58受体数量.结果 术野血和回收血的RCR分别为32.3%±6.9%和25.6%±5.0%.RCIR分别为13.3%±6.8%和7.9%±1.6%,回收血的RCR和RCIR均明显低于术野血(P<0.05).回收血红细胞膜表面CD35和CD58的荧光强度分别为27.6±1.9和21.4±3.3,均明显低于术野血CD35(35.1±4.4,P<0.01)和CD58(27.3±5.5,P<0.05)的荧光强度.结论 目前采用的自体血回收技术对红细胞的免疫功能有一定抑制作用,其机制可能与红细胞表面免疫受体的数量减少有关.     

Partial Bowls Using the Haemonetics Cell Saver 5: Does It Produce a Quality Product?

Controversy still exists on the validity of processing a partial bowl during the collection of shed blood lost through surgery during cell salvaging. The purpose of this study was to assess the quality of red blood cells produced from a partial bowl of autologous suctioned blood using the Haemonetics Cell Saver 5. Suctioned blood was collected from 17 patients undergoing cardiac surgery. A partially filled cell saver bowl was washed with 1500 mL of NaCl. Reservoir and processed blood samples were examined for potassium, leukocytes, hematocrit, platelets, and plasma-free hemoglobin and then compared with 22 previously studied full bowls. Results are summarized in the table below: In conclusion, the Haemonetics Cell Saver 5 can produce a quality product from washing a partial bowl with a better washout of white blood cells compared with a full bowl. However, there is a reduction in red blood cell recovery.     

Rate and risk factors for blood transfusion in patients undergoing periacetabular osteotomy

Periacetabular osteotomy has become the procedure of choice in many centers for the treatment of symptomatic hip dysplasia in young patients without severe secondary hip arthritis. Reorientation pelvic osteotomy has the potential for large blood loss and the need for blood transfusion. Between 1996 and 2003, 108 periacetabular osteotomies (107 patients) were performed by one of the authors. There were 84 females and 23 males with an average age of 30 years at the time of surgery. The overall allograft transfusion rate was 20% (21/108). Ninety-four percent (101/108) of the patients received transfusions including autologous blood, intraoperative cell saver, and postoperative allograft transfusion. The average transfusion amount (cell saver and allograft) was 2.14 units per patient. The risk for transfusion between males and females was not significantly different. The data from this study suggest that the vast majority of patients undergoing periacetabular osteotomy will require some form of transfusion, with 20% requiring allograft blood. The need for allograft blood will be minimal if the preoperative hemoglobin is greater than 12 g/dL.     

Preoperative autologous blood donation with cardiac surgery

BACKGROUND: Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The purpose of this study was to ascertain how much volume of predonated autologous blood need to avoid of homologous blood transfusion in cardiac procedure. METHODS: One hundred twenty-eight patients underwent scheduled cardiac procedure between January 1998 and December 1999. Group 1: 400 ml predonated, operation without cardiopulmonary bypass (CPB) [n = 33], group 2: 800 ml predonated, operation without CPB (n = 23), group 3: 800 ml predonated, operation with CPB (n = 36), group 4: 1,200 ml predonated, operation with CPB (n = 36). Surgical procedures underwent only off-pump coronary artery bypass grafting (OPCAB) in groups 1 and 2. In groups 3 and 4 included coronary artery bypass grafting (CABG), valve replacement, CABG + valve replacement and atrial septal defect repair. RESULTS: There were no significant differences in mean body weight, mean preoperative hematocrit values or mean volume of intraoperative blood loss between groups 1 and 2. There were no significant differences in mean age, mean body weight, mean preoperative and postoperative day-7 hematocrit values, mean volume of intraoperative blood loss or mean CPB time between groups 3 and 4. The mean postoperative day-7 hematocrit value was significantly lower in group 1 than in group 2. Homologous blood transfusion was avoided in 63.6% of those with predonation of group 1 versus 100% at group 2 (p < 0.05), 86.1% at group 3 versus 94.4% at group 4 (p < 0.05). In group 3, all patients who underwent redo operation or CABG + valve replacement needed homologous blood transfusion. CONCLUSIONS: Autologous blood transfusion is effective for reducing the homologous blood requirement. It also seems that predonation of 800 ml may be sufficient to avoid homologous blood transfusion in cardiac surgery, however predonation of 1,200 ml is desirable in cases of redo operation or CABG + valve replacement.     

Tolerance and efficacy of delayed autologous transfusion in cardiovascular surgery

Over a period of 18 months, 313 patients (mean age 52 years) undergoing elective cardiovascular surgery were included in the autologous transfusion program involving two different Transfusion Centres. A further 10 patients were excluded because of anaemia (haemoglobin levels less than 11 g.dl-1) (n = 3), angina pectoris less than 8 days before (n = 3), patient refusal (n = 2), pneumonia (n = 1), and severe aortic insufficiency (n = 1). A maximum of 5 ml.kg-1 of blood was obtained during the 3 to 4 weeks prior to surgery, one donation being taken a week. In one Transfusion Centre, the blood was taken without tourniquet, and without any fluid replacement. Diuretics and converting enzyme inhibitors were stopped. In the opposite, in the other Centre, blood was taken using a tourniquet, and replaced by a gelatin solution (Plasmion). All the patients were given iron. The blood units were kept by the Transfusion Centres under the same conditions as homologous blood, but in a separate circuit. The 313 patients predeposited a mean of 2.71 units of blood: 4 units where obtained in 59 patients, 3 in 113, 2 in 133 and only 1 in 8. Mean haemoglobin level on starting the program was 14.49 g.dl-1. Neither homologous red cells nor plasma was administered in 176 patients (56.23%); among the 172 patients who predeposited 3 or 4 units, 123 (71.5%) were given their own blood only. Intraoperative blood salvage was used in 189 out of 313 patients (60.4%), and intraoperative haemodilution with albumin was used in 173 patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of a new ultrafiltration blood processing system

Purpose

To report our clinical experience with a new blood processing device which uses ultrafiltration. We assessed safety and efficacy by evaluating: I) the quality and the quantity of intraoperative shed blood processed and reinfused to the patient 2) homologous blood requirements 3) clinical status of the patient post-transfusion.

Methods

With Ethics Committee approval, the ultrafiltration device was used in six consenting patients undergoing major elective spinal surgery. Blood samples for haematology and biochemistry tests were collected from patients post-induction of anaesthesia (baseline). I hr and 24 hr post-autotransfusion. Volumes of blood collected and processed, and all autologous and homologous transfusions were recorded. Patients were assessed postoperatrvely for any adverse effects.

Results

Five patients had donated blood preoperatively. One patient required homologous blood products in addition to autologous blood. In two patients, the filtration cartndge became blocked and required changing midprocessing. No patient sustained device-related complications. One patient had postoperative haematuna which resolved spontaneously within two hours.

Conclusion

The ultrafiltration device was safe and effective in reducing homologous blood requirements in six patients undergoing elective spinal surgery. Further evaluation of the ultrafiltration device will be necessary, especially in view of the blockage of the filtration cartndge.     

Intraoperative red blood cell salvage and autologous transfusion during open radical retropubic prostatectomy: a cost-benefit analysis

INTRODUCTION

Open radical retropubic prostatectomy (RRP) has an average blood loss of over 1,000ml. This has been reported even from high volume centres of excellence.^1–4 We have looked at the clinical and financial benefits of using intraoperative cell salvage (ICS) as a method of reducing the autologous blood transfusion requirements for our RRP patients.

MATERIALS AND METHODS

Group A comprised 25 consecutive patients who underwent RRP immediately prior to the acquisition of a cell saver machine. Group B consisted of the next 25 consecutive patients undergoing surgery using the Dideco Electa (Sorin Group, Italy) cell saver machine. Blood transfusion costs for both groups were calculated and compared.

RESULTS

The mean postoperative haemoglobin was similar in both groups (11.1gm/dl in Group A and 11.4gm/dl in Group B). All Group B patients received autologous blood (average 506ml, range: 103–1,023ml). In addition, 5 patients (20%) in Group B received a group total of 16 units (average 0.6 units) of homologous blood. For Group A the total cost of transfusing the 69 units of homologous blood was estimated as £9,315, based on a per blood unit cost of £135. This cost did not include consumables or nursing costs.

CONCLUSIONS

We found no evidence that autologous transfusions increased the risk of early biochemical relapse or of disease dissemination. ICS reduced our dependence on donated homologous blood.