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.     

Intraoperative autologous transfusion in revision total hip arthroplasty

The records of ninety-eight patients (100 hips) who had revision total hip arthroplasty were reviewed to evaluate the efficacy of intraoperative autologous transfusion in reducing homologous blood-transfusion requirements. In the fifty hips in the study group, a mean of 685 milliliters of autologous blood, or 47 per cent of the estimated loss of blood, was transfused intraoperatively. During the entire course of hospitalization, the mean of the total homologous blood-transfusion requirements was 795 milliliters in thirty-nine study-group patients, compared with 1160 milliliters in forty-six control-group patients who did not have autologous transfusion. This difference was statistically significant (p less than 0.029). Eleven patients in the study group and four patients in the control group did not receive homologous blood. Over-all, the use of intraoperative autologous transfusion was directly responsible for a 42 per cent reduction in the total amount of homologous blood that was transfused.     

髋关节手术应用自体血回收技术的效果分析

背景：自体血回输可有效提供相容性血细胞,及时补充血容量,减少异体血输入量,降低异体输血的并发症,对机体的凝血功能无不良影响,因而越来越受到人们的重视。目前,有关髋关节手术应用该技术的临床研究甚少。 目的：观察髋关节手术中自体血回输技术（IOCS）的临床应用效果。 方法：选择40例髋关节手术患者,随机分为自体血回输组（实验组）20例和输注异体血组（对照组）20例。观察不同时段血常规、凝血时间的变化以及并发症发生情况。 结果：实验组比对照组共节约库存用血约8000 ml。A组患者自体血回输即刻与术前相比血红蛋白（Hb）降低,但很快恢复正常,4 d后红细胞计数（RBC）、Hb、红细胞压积（Hct）与术前相比无统计学差异。血小板计数（PLT）及凝血酶原时间（PT）与术前相比有统计学差异（P＜0.05）,与B组相比无统计学差异（P＞0.05）。 结论：IOCS是一种安全有效的节约用血方法,适合在骨科髋关节手术中推广。     

Intraoperative cell salvage with autologous transfusion in liver transplantation

Liver transplant(LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others.Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion.Intraoperative reinfusion of autologous blood is possible through previous selfdonation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion(IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.     

Intraoperative, salvaged, autologous blood transfusion in oncologic surgery

Intraoperative, salvaged, autologous blood transfusions carried out with autotransfusion devices are commonly used for cardiovascular surgery, and also enable the treatment of massive hemorrhage in orthopedic and gynecologic surgeries to prevent potential complications of homologous blood transfusions, such as transmission of infection, immune reactions, and blood type incompatibility. Transfusion of salvaged blood in oncologic surgery may cause hematogenous metastasis and dissemination of malignant tumor cells. However, some investigators have reported that blood irradiation or filtration using leukocyte reduction filters can prevent contamination by malignant tumor cells. Intraoperative autotransfusion with the combination of blood irradiation and leukocyte reduction filters could be therefore a promising technique for the treatment of profuse hemorrhage in oncologic surgery.     

Intraoperative autologous transfusion in primary and revision total hip arthroplasty

Significant blood loss during total hip arthroplasty is usually unavoidable. Blood loss is even more of a problem during revision total hip arthroplasty. Using the Cell-Saver for retrieval of red blood cells to be used for autotransfusion during surgery is a safe and useful way of sparing donor blood transfusion. This is a retrospective analysis of primary and revision total hip arthroplasty cases and comparison between cases in which Cell-Saver was used versus those in which Cell-Saver was not used. Generally accepted standards to determine the need for blood transfusion, including measured serum hemoglobin and patient symptoms and vital signs, were used as guidelines in treating patients. Using multiple regression models and taking into account certain variables between cases, it was determined that a significant amount of donor blood transfusion can be saved when the Cell-Saver is used. The Cell-Saver is an important aid in intraoperative treatment for both primary and revision total hip arthroplasty cases.     

Intraoperative autologous blood transfusion: report of a technique.

Using a simple and relatively inexpensive technique, blood was salvaged during major thoracic and cardiovascular surgery in 34 cases. Detailed haematological, biochemical, and bacteriological studies were carried out, with red cell survival studies. It has been shown that cellular as well as non-cellular elements of the blood were well preserved with little or nor bacterial contamination. It has been suggested that this form of autologous blood is a more suitable form of blood replacement than donor blood.     

Fibrinolytic activity and postoperative salvaged untreated blood for autologous transfusion in major orthopaedic surgery.

OBJECTIVE: To evaluate the fibrinolytic activity in a closed surgical wound, in postoperatively drained blood, and during autologous transfusion. DESIGN: Prospective study. SETTING: National hospital, Norway. PATIENTS: 9 patients operated on for thoracic scoliosis. MAIN OUTCOME MEASURE: Concentrations of plasmin/antiplasmin (PAP), alpha2-antiplasmin, and D-dimers in drained, arterial, and mixed venous blood before, during, and after infusion of 10 ml/kg body weight of postoperatively drained, untreated blood. RESULTS: In drained blood the concentration of alpha2-antiplasmin was 31% of the preoperative arterial control value. Together with the increased concentrations of PAP to 18076 microg/L and D-dimers to 126 mg/L, this indicates extensive fibrinolytic activity in the closed wound. The postoperative autologous transfusion of drained, untreated blood increased the concentration of PAP from 507 to 2453 microg/L and of D-dimer from 0.7 mg/L to 15.3 mg/L in systemic blood. CONCLUSION: The systemic concentration of fibrin(ogen) degradation products, indicated by D-dimers, after recirculation of drained, untreated blood might impair coagulation. The extensive activation of plasmin might exhaust available alpha2-antiplasmin in the wound and result in postoperative rebleeding.     

Intraoperative autologous transfusion during elective infrarenal aortic reconstruction: A decision analysis model

Purpose: The use of intraoperative autologous transfusion devices expanded during the last decade as a result of the increased awareness of transfusion-associated complications. This study was designed to determine whether routine use of an intraoperative autologous transfusion device (Haemonetics Cell Saver [CS]) during elective infrarenal aortic reconstructions is cost-effective ($50,000/QALYs threshold).Methods: A decision analysis tree was constructed to model all of the complications that are associated with red blood cell replacement during aortic reconstructions for both abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD). It was assumed that a unit of CS return (CSR; 250 ml/unit) equaled a unit of packed red blood cells (PRBCs) and that all CS transfusions were necessary. Transfusion requirements (AAA: PRBC = 2.8 ± 3.2 units, CSR = 3.7 ± 3.2 units; AIOD: PRBC = 3.1 ± 3.0 units, CSR = 2.1 ± 1.7 units) were determined from retrospective review of all elective aortic reconstructions (AAA, N = 63; AIOD, N=75) from Jan. 1991 to June 1995 in which the CS was used (82.1% of all reconstructions). Risk of allogenic transfusion-related complications (transfusion reaction, hepatitis B, hepatitis C, human immunodeficiency virus, human T-cell lymphotropic virus types I and II) and their associated treatment costs (expressed in dollars and quality-adjusted life years (QALYs) were obtained from the medical literature, institutional audit, and a consensus of physicians.Results: Routine use of the CS during elective infrarenal aortic reconstructions was not cost-effective in our practice. Use during reconstructions for AAA repairs cost $263.75 but added only 0.00218 QALYs, for a rate of $120,794/QALY. Use during reconstructions for AIOD was even more costly at $356.68 and provided even less benefit at 0.00062 QALYs, for a rate of $578,275/QALY. The sensitivity analyses determined that the routine use of the CS would be cost-effective in our practice only for AAA repairs if the incidence of hepatitis C were tenfold greater than the baseline assumption. The model determined that CS was cost-effective if the CSR exceed 5 units during reconstructions for AAA and 6 units during reconstructions for AIOD.Conclusions: The routine use of the CS during elective infrarenal aortic reconstructions is not cost-effective. The use of the device should be reserved for a select group of aortic reconstructions, including those in which cost-effective salvage volumes are anticipated. Alternatively, the CS should be used as a reservoir and activated as a salvage device if significant bleeding is encountered. (J Vasc Surg 1997;25:984-94.)     

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目的 观察老年人术前储存式自体输血的临床效果。方法 自决定放行储存式自体输血之日起,入选病例每天口服多糖铁１５０ｍｇ,每日２次,采血前１小时控予采血量的３倍给予晶、胶液体（晶、胶液体量比例为２：１）经外周静脉输入,然后经另一侧静脉采血,每次采血４００ｍｌ,同隔７２小时采血１次,部采血量不应超过１２００ｍｌ。结果 除２例病人因术中失血量过多同时输注异体血外,其余病人均未用异体血,其余病人均未恢复良好     

Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation

INTRODUCTION

A number of ways of reducing blood loss in arthroplasty have been explored, including preoperative autologous transfusion, intraoperative cell salvage and postoperative autologous transfusions. Both intraoperative blood salvage and postoperative retransfusion drains have been shown to be effective in reducing blood loss in total hip arthroplasty. In our department there was a change in practice from using postoperative retransfusion drains to intraoperative cell salvage. To our knowledge no study has directly compared using intraoperative blood salvage and postoperative retransfusion drains alone in total hip arthroplasty.

METHODS

This was a retrospective service evaluation including all primary hip arthroplasty performed under our care between January 2006 and December 2008. Patients were divided into two groups: Group A used a postoperative autologous blood transfusion (ABT) drain and Group B used intraoperative cell salvage.

RESULTS

A total of 144 patients were included in this study: 84 in Group A and 60 in Group B. The mean haemoglobin difference for Group A was 3.96g/dl (standard deviation [SD]: 1.52) and for Group B it was 3.46g/dl (SD: 1.42). The mean haematocrit difference for Group A was 0.12% (SD: 0.05) and for Group B it was 0.10% (SD: 0.04). Using an independent t-test for the comparison of means, a significant difference was found between Group A and B both in regards to haemoglobin difference (p=0.009) and haematocrit difference (p=0.046).

CONCLUSIONS

We feel that intraoperative cell salvage provides a more efficient method of reducing blood loss than postoperative retransfusion in primary total hip replacement. A prospective randomised study would be useful to ascertain any clinical difference between the two methods.     

Intraoperative autologous blood transfusion was effective in a massive blood loss during living-related donor liver transplantation

We have experienced massive blood loss (> 80,000 g) during living-related donor liver transplantation (LRDLT) of a 14-year old girl with biliary atresia. As available homologous blood was not sufficient, we transfused autologous blood (13,400 ml) during operation. Although immunosuppressant was administered to the patient, severe infection did not occur for 10 days after the operation. Cold ischemia time of the graft liver was about 16 hr, but her postoperative liver function was well-maintained. The case suggests that intraoperative autologus blood transfusion is effective if homologous blood is insufficient during LRDLT.     

Necessity for autologous blood storage and transfusion in patients undergoing pancreatoduodenectomy

Purpose

To establish which patients undergoing pancreaticoduodenectomy (PD) need autologous blood storage and transfusion.

Methods

Autologous blood was collected and stored for 69 patients scheduled to undergo PD, and not used in 50 patients. Based on the use of the deposited autologous blood and the estimated postoperative hemoglobin (Hb) level when blood was not deposited, we divided the patients into a “transfusion necessary” group and a “transfusion unnecessary” group. By comparing the two groups, we proposed a method of scoring to predict the necessity for storing autologous blood.

Results

The “transfusion necessary” group comprised 6 patients (2 who received homologous blood transfusion and 4 with an estimated postoperative Hb of <8.0 g/dL) and the “transfusion unnecessary” group comprised 63 patients (24 whose autologous blood was discarded and 39 with an estimated Hb ≥8.0 g/dL). By analyzing the differences between the groups, including the preoperative hemoglobin level and the need for portal vein resection, we devised a scoring system to predict the necessity of collecting autologous blood. The scoring significantly correlated with the proportion of patients who did not require autologous blood storage and transfusion.

Conclusions

Not all patients benefited from autologous blood storage and transfusion. Our scoring system proved useful for identifying which patients required autologous blood storage and transfusion during PD.

     

原位自体心脏移植手术的护理配合

对3例患者施行自体心脏移植手术,均获成功。提出护士术前学习手术相关步骤;术中巡回护士严密观察病情,及时提供台上所需物品,做好心室颤动及大出血应对,维持术中循环稳定,正确使用血液回收设备,做好术中皮肤保护;器械护士熟悉手术步骤,术中加强手术器械及缝针管理,并严格执行无菌操作原则,降低术后感染的发生是其配合要点。     

Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery.

OBJECTIVE: Our purpose was to evaluate the efficacy and safety of intraoperative autologous blood transfusion during laparoscopic surgery for hemoperitoneum in benign gynecologic disease. METHODS: The Cell Saver, Haemo Lite 2, an intraoperative autologous blood salvage device, was used in laparoscopic surgery on 18 patients with ectopic pregnancies or ovarian bleeding who had a large hemoperitoneum with/without severe anemia and hypovolemic shock. RESULTS: The blood loss was 1186 +/- 789 mL, and the volume of reinfused processed blood was 661 +/- 405 mL in ectopic pregnancy cases. The blood loss was 716 +/- 219 mL, and the volume of reinfused processed blood was 496 +/- 138 mL in ovarian bleeding. Laparoscopic surgery was performed and homologous blood transfusion was not required in any patient. No adverse reactions or procedural difficulties associated with the autologous blood transfusions occurred. CONCLUSIONS: Intraoperative autologous blood transfusion enabled the performance of laparoscopic surgery for large hemoperitoneum caused by ectopic pregnancies or ovarian bleeding without a homologous blood transfusion.     

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.