Hemolysis and red blood cell mechanical fragility in shed blood after total knee arthroplasty

BACKGROUND: There are several options for the salvage of postoperative shed red blood cells (RBCs). This study compared the characteristics of the returned RBCs collected using two different devices: one that washes and one that does not wash the collected RBCs. STUDY DESIGN AND METHODS: Forty patients undergoing first‐time total knee arthroplasty consented to participate. Twenty patients were operated on by a surgeon who routinely uses a device that does not wash the shed RBCs (unwashed group), the other 20 patients were operated on by surgeons who routinely use a device that washes and concentrates the collected RBCs (washed group). A small quantity of postprocessing RBCs were collected immediately before reinfusion and the amount of plasma‐free hemoglobin (PFHb), and the mechanical fragility index (MFI) of the returned RBCs were determined. RESULTS: The patients in both groups were well matched for age, sex, and length of stay. The mean percent hemolysis of the returned RBCs was not different between the unwashed and washed groups (1.22 ± 0.30 vs. 1.24 ± 0.42, p = 0.895), while the mean total amount of returned PFHb was not different (0.51 ± 0.12 g vs. 0.55 ± 0.35 g, p < 0.615). The ratio of total PFHb:total returned Hb was significantly lower for the washed group (0.0087 ± 0.0023 vs. 0.0035 ± 0.0011, p < 0.0001). The MFI was higher in the washed group (1.71 ± 0.55 vs. 0.53 ± 0.42, p < 0.001). CONCLUSIONS: The washing device returned more Hb to the patients relative to the amount of free Hb.     

Utility of red blood cell apheresis in autologous blood donation

Although autologous blood donation is an alternative to allogeneic transfusion, some authors had questioned its cost-effectiveness. New techniques, like red blood cell apheresis could improve the cost-effectiveness of autologous blood transfusion, therefore we have valued the efficiency of this procedure in autologous blood donation. MATERIALS AND METHODS: We studied 131 patients undergoing different types of surgery who entered the preoperative autologous blood donation program over a one year period. Apheresis was performed with the MCS 3p from Haemeonetics. RESULTS: We were able to collect 304 red blood cell units from 131 patients. The average yield per procedure was two units (88 cases, 67.2%). In 41 patients (31.3%), we collected 3 units and, in two cases, 4 units were collected. The mean volume of the units was 255 (191-280). 18 (13.7% patients had an adverse reaction. Most of these were mild. Only in one case was it necessary to stop the procedure. 202 units (66.4%) were transfused to 97 patients (74%). 12 (9.2%) patients also used allogeneic transfusions (mean units: 0.18+/-0.05 with a range 1-5). CONCLUSION: Red blood cell apheresis is a useful procedure in autologous blood donation.     

Volume studies. II. Simultaneous determination of plasma volume, red cell mass, extracellular fluid, and total body water before and after volume expansion in dog and man.

A method for the simultaneous determination of plasma volume, red cell mass, extracellular fluid volume, and total body water is described. Plasma volume and red cell mass were determined by a standard dual gamma-tracer technique using 125radioiodinated labeled human serum albumin (125RISA) and 51radiochromate-tagged red cells (51Cr-RBC). Extracellular fluid volume and total body water were determined by a dual beta-tracer technique which utilized radiosulfate-35 (35SO4) and tritiated water (THO), respectively. Kinetic studies of each radionuclide in normal and fluid expanded states demonstrated equilibration of 125RISA and 51Cr-RBC in 5 minutes, 35SO4 and THO in 30 minutes. The results of the volume studies in dog and man demonstrated less than 10 per cent variation on repetitive study, and better than 70 per cent accuracy in estimating a known fluid change. This technique will enable a more precise and simplified investigation of the physiology of body fluid volume regulation in health and disease.     

Possible guidelines for autologous red blood cell donations before total hip arthroplasty based on the surgical blood order equation

OBJECTIVES: To determine, in patients undergoing total hip arthroplasty (THA), clinical predictive criteria for preoperative autologous blood donation and to propose guidelines to increase the efficiency and reduce the cost of preoperative autologous blood donation. PATIENTS AND METHODS: In this retrospective analysis of 165 adult patients undergoing primary THA, a stepwise regression analysis was used to determine which clinical variables predict erythropoiesis in patients donating autologous blood before THA. The surgical blood order equation (SBOE), which includes values for hemoglobin lost at surgery, preoperative hemoglobin level, and minimal acceptable hemoglobin level, was used to estimate the number of units of red blood cells (RBCs) needed for each patient at surgery and thus identify which patients should have made preoperative autologous blood donations. RESULTS: The statistically significant indicators for RBC production were predonation hemoglobin concentration (P<.001) and male sex (P=.003). Combining the regression equation for erythropoiesis with the SBOE allowed development of guidelines for the use of preoperative autologous RBC donation and erythropoietic therapy. For primary THA surgery, a patient with a predonation hemoglobin level higher than 14.7 g/dL does not need preoperative autologous donation. Preoperative autologous RBC donation would be effective for men with hemoglobin concentrations of 14.7 g/dL or less and for women with predonation hemoglobin levels of 13.2 to 14.7 g/dL. In women whose hemoglobin level is less than 13.2 g/dL, erythropoietic therapy should accompany autologous donation. CONCLUSION: Incorporation of patient factors with the SBOE system may result in increased efficiency and decreased cost of autologous blood ordering practices before THA.     

CFU-GM and T cell subsets in young red cell collections

Young red cells (YRBCs) prepared using cell separators contain large numbers of white cells. The absolute numbers and percentages of different lymphocyte subsets and progenitor cells in YRBC collections were assessed before and after filtration through two white cell filters. It was found that the filters do not take up or selectively allow through any one lymphocyte subset and that the absolute number of T cells and progenitor cells in YRBC collections after filtration is less than that in normal donor blood.     

Preoperative red cell production in patients undergoing weekly autologous blood donation

BACKGROUND: Modest autologous blood donation programs involving weekly phlebotomy and threshold hematocrits for blood donation higher than 33 percent are frequently used in patients scheduled for elective cardiac surgery. This study was performed to determine the gain in red cells (RBCs) obtained with such a program. STUDY DESIGN AND METHODS: The blood bank and medical records of 225 adult patients (194 men, 31 women; mean age, 57 years [range, 18–77]) who donated blood for autologous use in elective cardiac surgery during a 3-year period were reviewed. Preoperative RBC production was estimated by the total volume of RBCs donated minus the change in circulating RBC volume between the first donation and the day before surgery. RESULTS: A total of 604 blood units were donated (2.7 units/patient; range, 1–3). The mean volume of RBCs donated was 522 mL (range, 171–732). Mean RBC production (over baseline RBC production) was 351 mL (range, 9–719), or 19 percent (range, 0.5-40) of the circulating RBC volume at baseline. CONCLUSION: A modest autologous blood donation program using three phlebotomies at weekly intervals and a threshold hematocrit for blood donation of 36 percent yields an average of 351 mL (range, 9–719) of RBCs. This is equivalent to 2 units (range, 0.5-4) of allogeneic packed RBCs at 180 mL per unit.     

Effect of long-term physical training on total red cell volume

Six months of military training elicited a significant 4% mean increase in total red cell volume (TRC) measured by the 51Cr-labelled red cell method. This increase was associated with a mean 16% increase in predicted maximal oxygen uptake (VO2max). The increases in TRCV and predicted VO2max were inversely related to their initial levels. A statistically highly significant correlation between TRCV and predicted VO2max was observed (r = 0.59). The trained group had larger initial TRCVs than the sedentary group and the subjects who became well conditioned had a significant increase in TRCV, which contrasted with the unchanged TRCV in the subjects who did not become well conditioned. The greatest increase in TRCV (11%) was found in corporals, who had the hardest training. A statistically significant correlation between the changes in TRCV and estimated plasma volume was observed (r = 0.62), P less than 0.001). Owing the 1.8% increase in body weight the TRCV and predicted VO2max in terms relative to the body weight did not demonstrate the changes as clearly as did the absolute values. The factors affecting the TRCV increase are discussed.     

Determination of red cell volume in infants needing blood transfusion

The total circulating red cell volume (RCV) is a better guide to the oxygen-carrying capacity of the blood in the whole circulation than is the haemoglobin concentration (Hb) or haematocrit in a blood sample. Pre- and post-transfusion RCV (and blood volume (BV)) may be determined by flow cytometry by exploiting antigen differences between transfused donor red cells and the recipient's red cells. This paper describes the use of red cell antigen differences of Duffy, Kidd, MN and RhD between donor and recipient. In 20 infants, transfused on 21 occasions, pretransfusion RCV ranged from 12 to 39 mL kg(-1) body weight. Only at one transfusion could no usable donor-recipient antigen differences be exploited. Measurement of RCV, used routinely, may determine the transfusion requirements of sick infants more accurately, with the aim of normalizing RCV and BV--securing euvolaemia--at the end of the transfusion. This may allow a complete correction of the RCV deficiency at the first occasion of transfusion. This approach may reduce donor exposures and also optimize oxygen transport and organ perfusion of the infant undergoing intensive management, perhaps leading ultimately to improved survival rates and fewer long-term complications of neonatal intensive care.     

高渗盐溶液治疗创伤后微血管、大血管血容量和总血容量的变化

目的：探讨烧伤冲击伤复合伤后一次性输入高渗盐溶液抗休克治疗的效果及机制。方法：实验采用狗烧伤冲击伤复合伤模型，观察复合伤后２小时一次性分别静脉给予７．５％ＮａＣｌ＋６％葡聚糖７０（ＨＳＤ）和乳酸林格氏液（ＬＲ）治疗后血压、心输出量、红细胞压积及血浆粘度等的变化，并在此基础上计算微血管血容量、大血管血容量和总血容量的变化。结果：复合伤后血压和心输出量明显降低，红细胞压积显著升高。早期使用ＨＳＤ治疗较ＬＲ能更显著地回升血压和心输出量，降低红细胞压积，非常显著地增加总血容量，其中以大血管血容量增加为主；而ＬＲ治疗则以微血管血容量增加为主。结论：ＨＳＤ治疗通过显著增加大血管血容量，维持微血管血容量，因而有效恢复血压和心输出量、减轻组织水肿，优于ＬＲ治疗。     

Reduced volume of red blood cell priming is safe for pediatric patients undergoing therapeutic plasma exchange

RationalTherapeutic Plasma Exchange (TPE) procedures in pediatric patients are challenging due to the large extracorporeal volume of the cell separators, which were designed for adults. Red blood cell (RBC) priming is an alternative for overpassing the risks of hypovolemia, but data referring to the volume of packed RBCs to be infused are yet incomplete. Restricting the volume of RBC priming may potentially be associated with less transfusion reactions.GoalTo determine the safety of administering a reduced volume of RBC priming for pediatric patients undergoing TPE, in comparison to the standard volume recommended by the cell separators’ manufacturers.MethodsThis was a case-control study which enrolled 15 pediatric patients undergoing TPE and weighting more than 10Kg. The TPE procedures (n = 406) were divided in two groups: 1) Group1: TPE with ≤150 mL of packed RBC priming and 2) Group2: TPE with 150-250 mL of RBC priming. Groups were compared in terms of hemoglobin / hematocrit and occurrence of adverse reactions.ResultsGroup1 and Group2 did not differ significantly in relation to pre- and post-TPE hemoglobin (Hb) levels (p = 0.19 and p = 0.18, respectively). The Δ Hb (Hb pre-TPE – Hb post-TPE) was also not statistically different between the groups. The number of adverse reactions was significantly higher in Group 2 in relation to Group 1 (p = 0.01). The number of allergic reactions was also higher in Group 2 (p = 0.06).ConclusionsRestricting the volume of RBC priming to less than 150 mL is safe for pediatric patients weighting more than 10Kg and associated with lower rates of transfusion-related adverse reactions.     

Changes in red blood cell membrane phosphate concentration during blood bank storage

The change in red blood cell membrane phosphate concentration of standard CPD whole blood stored in Fenwal blood bags at 4 C was measured daily for two weeks. Membrane phosphate concentrations increased rapidly when stored pH fell to 6.95. At the same time, the rate of K+ leakage from the cells increased, and transport of inorganic phosphate across the membrane decreased. It is concluded that gross uptake of phosphorus by the red blood cell membrane during blood bank storage may be in part responsible for physical changes in the membrane.     

Changes in circulating blood and plasma volume after hemoglobin-based oxygen carrier infusion and additional infusion of colloid solutions

The aim of this study was to investigate the changes in circulating blood volume (CBV) after infusions of Hemoglobin glutamer-200 (bovine; Hb-200) in combination with 6% hetastarch in an animal model of acute posthemorrhagic anemia. Fifteen rabbits with a mean body weight of 2.2 +/- 0.2 kg were studied. After determination of the circulating plasma volume (CPV) and CBV, one third of the CBV was withdrawn via an arterial catheter. An equal volume of Hb-200 was then infused in the 5 animals in study group 1. In the remaining 10 animals, the same volume of 6% hetastarch solution was infused. Fifteen minutes after completion of the infusion, an additional infusion of 6% hetastarch at a dose equal to one third of the baseline CBV was performed in study group 1 and the control group. In study group 2, equal volumes of Hb-200 were infused. CPV measurements were performed at baseline, after hemorrhage, 5 and 15 minutes after volume replacement, and 1 and 15 minutes after hypervolemic hemodilution using the Evans blue dye dilution technique. The mean baseline CPV value was 53.4 +/- 1.1 mL/kg. The mean CBV at baseline was 90.8 +/- 4.9 mL/kg. After one third of the CBV was withdrawn, no differences in CBV or CPV were observed between the three groups. Replacement of one third of the CBV with Hb-200 significantly increased the CPV (73.7 +/- 1.8 mL/kg) when compared with the baseline level (53.5 +/- 1.8 mL/kg; n = 5; P < 0.05). The difference between the groups was first observed 15 minutes after infusion. CPV was significantly higher in study group 1 (87.0 +/- 2.2 mL/kg) compared with the other groups (80.2 +/- 2.6 mL/kg in the control group and 79.5 +/- 3.6 mL/kg in study group 2). After a second transfusion, the differences between the groups became more prominent. Study group 2 demonstrated the highest CPV and CBV. The two study groups demonstrated a statistically significant increase in circulating volumes compared with the control group. The magnitude of this difference was lower than expected based on in vitro colloid osmotic pressure measurements.