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Bagwe S, Chung LK, Lagman C, Voth BL, Barnette NE, Elhajjmoussa L, Yang I. Blood transfusion indications in neurosurgical patients: A systematic review. Clin Neurol Neurosurg 2017; 155:83-89. [PMID: 28282628 DOI: 10.1016/j.clineuro.2017.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/07/2017] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
Abstract
Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. However, evidence-based guidelines concerning thresholds and indications for transfusion in neurosurgery remain limited. Consequently, transfusion practices in neurosurgical patients are highly variable and based on institutional experiences. Recently, a paradigm shift has occurred in neurocritical intensive care units, whereby restrictive transfusion is increasingly favored over liberal transfusion but the ideal strategy remains in clinical equipoise. The authors of this study perform a systematic review of the literature with the objective of capturing the changing landscape of blood transfusion indications in neurosurgical patients.
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Affiliation(s)
- Shefali Bagwe
- Departments of Neurosurgery, University of California, Los Angeles, United States
| | - Lawrance K Chung
- Departments of Neurosurgery, University of California, Los Angeles, United States
| | - Carlito Lagman
- Departments of Neurosurgery, University of California, Los Angeles, United States
| | - Brittany L Voth
- Departments of Neurosurgery, University of California, Los Angeles, United States
| | - Natalie E Barnette
- Departments of Neurosurgery, University of California, Los Angeles, United States
| | - Lekaa Elhajjmoussa
- Departments of Neurosurgery, University of California, Los Angeles, United States
| | - Isaac Yang
- Departments of Neurosurgery, University of California, Los Angeles, United States; Radiation Oncology, University of California, Los Angeles, United States; Head and Neck Surgery, University of California, Los Angeles, United States; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, United States.
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Li XL, Dong P, Tian M, Ni JX, Smith FG. Oxygen carrying capacity of salvaged blood in patients undergoing off-pump coronary artery bypass grafting surgery: a prospective observational study. J Cardiothorac Surg 2015; 10:126. [PMID: 26466895 PMCID: PMC4604709 DOI: 10.1186/s13019-015-0330-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/08/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intraoperative cell salvage (ICS), hereby referred to 'mechanical red cell salvage', has been widely used and proven to be an effective way to reduce or avoid the need for allogeneic red blood cells (RBCs)transfusion and its associated complications in surgeries involving major blood loss. However, little is known about the influence of this technique on the functional state of salvaged RBCs. Furthermore, there are no articles that describe the change of free hemoglobin (fHb) in salvage blood during storage, which is a key index of the quality control of salvaged blood. Therefore, in this study, the influence of ICS on the function of salvaged RBCs and the changes of salvaged RBCs during storage were studied with respect to the presence of oxyhemoglobin affinity (recorded as a P50 value) and the level of 2, 3-diphosphoglycerate (2, 3-DPG) and fHb by comparing salvaged RBCs with self-venous RBCs and 2-week-old packed RBCs. METHODS Fifteen patients undergoing off-pump coronary artery bypass grafting (OPCAB) surgery were enrolled. Blood was collected and processed using a Dideco Electa device. The level of P50, 2, 3-DPG and fHB from salvaged RBCs, venous RBCs and 2-week-old packed RBCs was measured. We also measured the changes of these indicators among salvaged RBCs at 4 h (storage at 21-24 °C) and at 24 h (storage at 1-6 °C). RESULTS The P50 value of salvaged RBCs at 0 h (28.77 ± 0.27 mmHg) was significantly higher than the value of venous RBCs (27.07 ± 0.23 mmHg, p=0.000) and the value of the 2-week-old packed RBCs (16.26 ± 0.62 mmHg, p=0.000). P50 value did not change obviously at 4 h (p=0.121) and 24 h (p=0.384) compared with the value at 0 h. The 2, 3-DPG value of salvaged RBCs at 0 h (17.94 ± 6.91 μmol/g Hb) was significantly higher than the value of venous RBCs (12.73 ± 6.52 mmHg, p = 0.007) and the value of the 2-week-old packed RBCs (2.62 ± 3.13 mmHg, p=0.000). The level of 2, 3-DPG slightly decreased at 4 h (p=0.380) and 24 h (p=0.425) compared with the value at 0 h. Percentage of hemolysis of the salvaged blood at 0 h(0.51 ± 0.27 %) was significantly higher than the level of venous blood (0.07 ± 0.05 %, p=0.000) and the value of 2-week-old packed RBCs (0.07 ± 0.05 %, p=0.000), and reached 1.11 ± 0.42 % at 4 h (p=0.002) and 1.83 ± 0.77 % at 24 h (p=0.000). CONCLUSIONS The oxygen transport function of salvaged RBCs at 0 h was not influenced by the cell salvage process and was better than that of the venous RBCs and 2-week-old packed RBCs. At the end of storage, the oxygen transport function of salvaged RBCs did not change obviously, but percentage of hemolysis significantly increased.
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Affiliation(s)
- Xiu Liang Li
- Department of Pain Management, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, 100053, Beijing, China.
| | - Peng Dong
- Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, 100050, Beijing, China.
| | - Ming Tian
- Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong'an Road, Xicheng District, 100050, Beijing, China.
| | - Jia Xiang Ni
- Department of Pain Management, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, 100053, Beijing, China.
| | - Fang Gao Smith
- Department of Anaesthesiology, the 2nd Affiliated Hospital & Yuying Children Hospital of Wenzhou Medical University, Wenzhou, China.
- Perioperative, Critical Care and Trauma Trials Group, University of Birmingham, Edgbaston B15 2WB, Birmingham, UK.
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Dong P, Che J, Li X, Tian M, Smith FG. Quick biochemical markers for assessment of quality control of intraoperative cell salvage: a prospective observational study. J Cardiothorac Surg 2014; 9:86. [PMID: 24886505 PMCID: PMC4046511 DOI: 10.1186/1749-8090-9-86] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoperative Cell Salvage (ICS), hereby referred to 'mechanical red cell salvage', has been widely used in adult elective major surgeries to reduce requirement for homologous red blood cell transfusion and its associated complications. However, amount of free haemoglobin (fHb) from ICS has been shown related to incidence of renal failure. fHb is the most important indicator of quality control of cell salvaged blood, thus monitoring the fHb concentration is imperative to minimise renal injury. However, currently there has been lacking quick biochemical markers to monitor the levels of fHb during ICS. The aim of this study was to screen quick biochemical markers for evaluating the amount of fHb during use of intraoperative cell salvage. METHODS Twenty patients undergoing elective cardiovascular surgery were enrolled. Blood was collected and processed using a Fresenius continuous auto-transfusion system device. The concentration of fHb, albumin (Alb), and calcium (Ca) in three washing modes were measured, and their clearance rates were calculated. The correlations among the clearances and concentrations of fHb, albumin, and calcium were analysed. RESULTS In three washing modes, concentrations of albumin and calcium are significantly associated with amount of fHb:fHb(g/L) = 0.111 Alb(g/L) -0.108, R = 0.638, p = 0.000; fHb(g/L) = 1.721 Ca(mmol/L) +0.091, R = 0.514, p = 0.000. Furthermore, the clearance rates of albumin and calcium significantly predict clearance of fHb, CR(fHb) = 0.310 CR(ALB) + 0.686, R = 0.753, p = 0.000, CR(fHb) = 0.073 CR(Ca) + 0.913, R = 0.497, p = 0.000. CONCLUSIONS In clinic practice, clearance rates of albumin, or calcium can be used to evaluate the quality of salvaged blood, fHb. Bed-side measurement of calcium could offer a more feasible means for clinicians to undertake a real-time assessment of fHb.
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Affiliation(s)
- Peng Dong
- Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Ji Che
- Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Xiuliang Li
- Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Ming Tian
- Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, 100050 Beijing, China
| | - Fang Gao Smith
- Perioperative, Critical Care and Trauma Trials Group, University of Birmingham, Edgbaston B15 2WB, Birmingham, UK
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Che J, Tian M, Ding G, Huai Q, Dong P, Li Y, Li S. Effects of cell salvage on erythrocyte 2,3-disphosphoglycerate and G-6-PD levels and phosphatidylserine expression. Int J Lab Hematol 2012; 35:385-92. [PMID: 23176294 DOI: 10.1111/ijlh.12028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/16/2012] [Indexed: 11/29/2022]
Affiliation(s)
- J. Che
- Department of Anesthesiology; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - M. Tian
- Department of Anesthesiology; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - G. Ding
- Department of Anesthesiology; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Q. Huai
- Department of Anesthesiology; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - P. Dong
- Department of Anesthesiology; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Y. Li
- Department of Anesthesiology; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - S. Li
- Department of Anesthesiology; Beijing Friendship Hospital; Capital Medical University; Beijing China
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Linsler S, Ketter R, Eichler H, Schwerdtfeger K, Steudel WI, Oertel J. Red blood cell transfusion in neurosurgery. Acta Neurochir (Wien) 2012; 154:1303-8. [PMID: 22585030 DOI: 10.1007/s00701-012-1373-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 04/26/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND The necessity of red blood cell (RBC) transfusions in neurosurgical procedures is under debate. Although detailed recommendations exist for many other surgical disciplines, there are very limited data on the probability of transfusions during neurosurgical procedures. METHODS Three-thousand and twenty-six consecutive adult patients undergoing neurosurgical procedures at Saarland University Hospital from December 2006 to June 2008 were retrospectively analyzed for administration of RBCs. The patients were grouped into 11 main diagnostic categories for analysis. The transfusion probability and cross-match to transfusion ratio (C/T ratio) were calculated. RESULTS Overall, the transfusion probability for neurosurgical procedures was 1.7 % (52/3,026). The probability was 6.5 % for acute subdural hematoma (7/108), 6.2 % for spinal tumors (5/80), 4.6 % for intracerebral hemorrhage (ICH, 4/98), 2.8 % for abscess (3/108), 2.4 % for traumatic brain injury (4/162), 2.3 % for cerebral ischemia (1/44), 1.9 % for subarachnoid hemorrhage (SAH) /aneurysms (4/206), 1.4 % for brain tumors (10/718), 0.8 % for hydrocephalus (2/196), 0.4 % for degenerative diseases of the spine (5/1290), including 3.6 % (3/82) for posterior lumbar interbody fusion (PLIF) and 0 % for epidural hematoma (0/15). The transfusion probabilities for clipping and coiling of SAH were 2.9 % (2/68) and 1.7 % (2/120) respectively. CONCLUSIONS The probability of blood transfusion during neurosurgical procedures is well below the 10 % level which is generally defined as the limit for preoperative appropriation of RBCs. Patients with spinal tumors, acute subdural hematomas or ICH, i.e., patients undergoing large decompressive procedures of bone or soft tissue, had a higher probability of transfusion.
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McDonnell NJ, Kennedy D, Long LJ, Gallagher-Swann MC, Paech MJ. The development and implementation of an obstetric cell salvage service. Anaesth Intensive Care 2010; 38:492-9. [PMID: 20514958 DOI: 10.1177/0310057x1003800313] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cell salvage in obstetric haemorrhage is now endorsed by a number of organisations. Most of the literature has focused on isolated case series and safety. We describe how cell salvage, including a quality assurance process conducted prior to clinical implementation, was introduced to our stand-alone obstetric hospital which had no previous experience of this technique. An implementation committee was established and 25 quality assurance and familiarisation cases were initially conducted. As part of this process the alpha fetoprotein, haematocrit, free plasma haemoglobin, potassium and Kleihauer tests were performed when enough blood was available for processing. Our guidelines for clinical use included women at greatly increased risk of obstetric haemorrhage and women at increased risk of haemorrhage who refused traditional transfusion. After the successful completion of this process, cell salvage was signed off for clinical use in March 2007 and was used on 51 occasions between March 2007 and July 2009. Twenty-one patients had salvaged blood re-transfused and for seven patients this was their only red blood cell replacement. The median blood loss in patients re-transfused was 3000 ml (range <500 to 8500 ml), with the median volume re-transfused 359 mi (range 60 to 1300 ml). There was one episode of unexplained hypotension associated with administration of salvaged blood. We have successfully introduced obstetric cell salvage into clinical practice. A quality assurance process prior to implementation was beneficial for the staff involved. Despite targeting a high-risk obstetric population, our re-transfusion rates are approximately 40%. No serious adverse events have been recorded. We recommend that in units that already provide intraoperative cell salvage in a non-obstetric setting, extending the service into obstetric situations should be considered. Units that routinely care for high-risk obstetric patients should also consider the introduction of such a service. Post transfusion Kleihauer testing should be performed as soon as possible in Rhesus-negative mothers who deliver a Rhesus-positive foetus, so that appropriate anti-D prophylaxis can be administered.
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Affiliation(s)
- N J McDonnell
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, University of Western Australia, Perth, Western Australia, Australia.
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Gueye PM, Bertrand F, Duportail G, Lessinger JM. Extracellular haemoglobin, oxidative stress and quality of red blood cells relative to perioperative blood salvage. Clin Chem Lab Med 2010; 48:677-83. [DOI: 10.1515/cclm.2010.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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