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Lugassy L, Marion S, Balthazar F, Cheng Oviedo SG, Collin Y. Impact of blood salvage therapy during oncologic liver surgeries on allogenic transfusion events, survival, and recurrence: an ambidirectional cohort study. Int J Surg 2024; 110:3392-3400. [PMID: 38666789 PMCID: PMC11175791 DOI: 10.1097/js9.0000000000001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/30/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION The use of autologous blood transfusions in oncologic surgeries is somewhat controversial due to the potential risk of disease dissemination through the salvage process. On the other hand, autologous blood transfusion can prevent the potential negative effects of allogenic blood transfusions and reduce use of valuable resources. METHODS This study included 106 adult patients who underwent oncologic liver surgery at our institution between December 2015 and June 2019. The patients were divided into two groups: the Cell Saver group (operated between January 2018 and June 2019) and the control group (operated between December 2015 and December 2017). The Cell Saver device was present in the operating room for the Cell Saver group, and blood was retransfused if a certain amount of blood loss occurred. Data analysis focused on outcomes such as blood transfusion requirements, overall survival, recurrence-free survival, hemoglobin levels, hospital stay, and complications. Patient records provided relevant information on demographics, surgery details, pathology, and outcomes for both groups. RESULTS Autologous blood transfusion was found to reduce the amount of blood units needed (4.0 units (control group) versus 0.4 units (Cell Saver group) P =0.029. Kaplan-Meier curves showed no difference for both overall survival 471.6 days (Cell Saver group) versus 468.3 days (control group) ( P =0.219) and 488.9 days (Cell Saver group) versus 487.2 days (control group) ( P =0.993) and disease-free survival ( P =0.553) and ( P =0.735) for primary hepatic tumors and hepatic metastasis respectively between the Cell Saver and control groups. Overall survival regardless of the type of tumor was similar to the control group (485.4 days vs. 481.9 days) ( P =0.503). Survival was significantly lower for minor hepatectomies (516.0 days vs. 517.4 days) ( P =0.050) in the Cell Saver group, major hepatectomies showed no difference in overall survival (470.2 days vs. 466.4 days) ( P =0.868). No impact on disease recurrence was found between patients who received autologous blood transfusions versus those who did not. CONCLUSION The use of Cell Saver should not be avoided in oncologic surgeries of the liver. Use of Cell Saver for major hepatectomies might be more beneficial as OS was significantly lower for the Cell Saver group for patients who underwent minor hepactomies. Further research is needed to explain this conflicting result. Nonetheless, the use of Cell Saver in autologous blood transfusions can reduce the use of valuable resources and the risks associated with allogenic blood transfusions.
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Affiliation(s)
| | | | | | | | - Yves Collin
- Department of Surgery
- Centre Intégré Universitaire de, Santé et de Services Sociaux de l’Estrie, Centre Hospitalier Universitaire de Sherbrooke (CIUSSSE - CHUS), Quebec, Canada
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Transfusion-free Strategies in Liver and Pancreatic Surgery: A Predictive Model of Blood Conservation for Transfusion Avoidance in Mainstream Populations. Ann Surg 2023; 277:469-474. [PMID: 36538643 DOI: 10.1097/sla.0000000000005757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of this study is to (1) describe the techniques and prove the feasibility of performing complex hepatobiliary and pancreatic surgery on a Jehovah Witness (JW) population. (2) Describe a strategy that offsets surgical blood loss by the manipulation of circulating blood volume to create reserve whole blood upon anesthesia induction. BACKGROUND Major liver and pancreatic resections often require operative transfusions. This limits surgical options for patients who do not accept major blood component transfusions. There is also growing recognition of the negative impact of allogenic blood transfusions. METHODS A 23-year, single-center, retrospective review of JW patients undergoing liver and pancreatic resections was performed. We describe perioperative management and patient outcomes. Acute normovolemic hemodilution (ANH) is proposed as an important strategy for offsetting blood losses and preventing the need for blood transfusion. A quantitative mathematical formula is developed to provide guidance for its use. RESULTS One hundred one major resections were analyzed (liver n=57, pancreas n=44). ANH was utilized in 72 patients (liver n=38, pancreas n=34) with median removal of 2 units that were returned for hemorrhage as needed or at the completion of operation. There were no perioperative mortalities. Morbidity classified as Clavien grade 3 or higher occurred in 7.0% of liver resection and 15.9% of pancreatic resection patients. CONCLUSIONS Deliberate perioperative management makes transfusion-free liver and pancreatic resections feasible. Intraoperative whole blood removal with ANH specifically preserves red cell mass, platelets, and coagulation factors for timely reinfusion. Application of the described JW transfusion-free strategy to a broader general population could lessen blood utilization costs and morbidities.
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Pinto MA, Grezzana-Filho TJM, Chedid AD, Leipnitz I, Prediger JE, Alvares-da-Silva MR, de Araújo A, Zahler S, Lopes BB, Giampaoli ÂZD, Kruel CRP, Chedid MF. Impact of intraoperative blood salvage and autologous transfusion during liver transplantation for hepatocellular carcinoma. Langenbecks Arch Surg 2020; 406:67-74. [PMID: 33025077 DOI: 10.1007/s00423-020-01997-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Intraoperative blood salvage (IBS) with autologous blood transfusion is controversial in liver transplantation (LT) for hepatocellular carcinoma (HCC). This study evaluated the role of IBS usage in LT for HCC. METHODS In a retrospective cohort study at a single center from 2002 to 2018, the outcomes of LT surgery for HCC were analyzed. Overall survival and disease-free survival of patients who received IBS were compared with those who did not receive IBS. Cancer recurrence, length of hospital stay, post-transplant complications, and blood loss also were evaluated. The primary aim of this study was to evaluate overall mid-term and long-term survival (4 and 6 years, respectively). RESULTS Of the total 163 patients who underwent LT for HCC in the study period, 156 had complete demographic and clinical data and were included in the study. IBS was used in 122 and not used in 34 patients. Ninety-five (60.9%) patients were men, and the mean patient age was 58.5 ± 7.6 years. The overall 1-year, 5-year, and 7-year survival in the IBS group was 84.2%, 67.7%, and 56.8% vs. 85.3%, 67.5%, and 67.5% in the non-IBS group (p = 0.77). The 1-year, 5-year, and 7-year disease-free survival in the IBS group was 81.6%, 66.5%, and 55.4% vs. 85.3%, 64.1%, and 64.1% in the non-IBS group (p = 0.74). For patients without complete HCC necrosis (n = 121), the 1-year, 5-year, and 7-year overall survival rates for those who received IBS (n = 95) were 86.2%, 67.7%, and 49.6% vs. 84.6%, 70.0%, and 70.0% for 26 patients without IBS (p = 0.857). For the same patients, the 1-year, 5-year, and 7-year disease-free survival in the IBS group was 84.0%, 66.8%, and 64.0% vs. 88.0%, 72.8%, and 72.8% in the non-IBS group (p = 0.690). CONCLUSION IBS does not appear to be associated with worse outcomes in patients undergoing LT for HCC, even in the presence of viable HCC in the explant. There seems to be no reason to contraindicate the use of IBS in LT for HCC.
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Affiliation(s)
- Marcelo A Pinto
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Tomaz J M Grezzana-Filho
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Aljamir D Chedid
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Ian Leipnitz
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - João E Prediger
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Mário R Alvares-da-Silva
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Alexandre de Araújo
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Sofia Zahler
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Bruno B Lopes
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Ângelo Z D Giampaoli
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Cleber R P Kruel
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil
| | - Marcio F Chedid
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Medical School of UFRGS, Porto Alegre, Brazil. .,Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS, Rua Ramiro Barcelos 2350, 6th Floor, Room 600, Porto Alegre, 90035-903, Brazil.
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Miller V, Pigott A. Traumatic haemothorax in a dog managed without surgery using a guidewire‐inserted chest tube and a single closed system for collection and administration of autotransfusion. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Armi Pigott
- Lakeshore Veterinary SpecialistsGlendaleWisconsinUSA
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Cell salvage in burn excisional surgery. Burns 2020; 47:127-132. [PMID: 33082023 DOI: 10.1016/j.burns.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hemostasis during burn surgery is difficult to achieve, and high blood loss commonly occurs. Bleeding control measures are limited, and many patients require allogeneic blood transfusions. Cell salvage is a well-known method used to reduce transfusions. However, its evidence in burns is limited. Therefore, this study aimed to examine the feasibility of cell salvage during burn surgery. STUDY DESIGN AND METHODS A prospective, observational study was conducted with 16 patients (20 measurements) scheduled for major burn surgery. Blood was recovered by washing saturated gauze pads with heparinized saline, which was then processed using the Cell Saver. Erythrocyte concentrate quality was analyzed by measuring hemoglobin, hematocrit, potassium, and free hemoglobin concentration. Microbial contamination was assessed based on cultures at every step of the process. Differences in blood samples were tested using the Student's t-test. RESULTS The red blood cell mass recovered was 29 ± 11% of the mass lost. Patients' preoperative hemoglobin and hematocrit levels were 10.5 ± 1.8 g/dL and 0.33 ± 0.05 L/L, respectively. The erythrocyte concentrate showed hemoglobin and hematocrit levels of 13.2 ± 3.9 g/dL and 0.40 ± 0.11 L/L thus showing a concentration effect. The potassium level was lower in the erythrocyte concentrate (2.5 ± 1.5 vs. 4.1 ± 0.4 mmol/L, p < 0.05). The free hemoglobin level was low (0.16 ± 0.21 μmol/L). All cultures of the erythrocyte concentrate showed bacterial growth compared to 21% of wound cultures. CONCLUSION Recovering erythrocytes during burn excisional surgery using cell salvage is possible. Despite strict sterile handling, erythrocyte concentrates of all patients showed bacterial contamination. The consequence of this contamination remains unclear and should be investigated in future studies.
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Kumar N, Ravikumar N, Tan JYH, Akbary K, Patel RS, Kannan R. Current Status of the Use of Salvaged Blood in Metastatic Spine Tumour Surgery. Neurospine 2018; 15:206-215. [PMID: 30071572 PMCID: PMC6226127 DOI: 10.14245/ns.1836140.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/13/2018] [Indexed: 12/15/2022] Open
Abstract
To review the current status of salvaged blood transfusion (SBT) in metastatic spine tumour surgery (MSTS), with regard to its safety and efficacy, contraindications, and adverse effects. We also aimed to establish that the safety and adverse event profile of SBT is comparable and at least equal to that of allogeneic blood transfusion. MEDLINE and Scopus were used to search for relevant articles, based on keywords such as "cancer surgery," "salvaged blood," and "circulating tumor cells." We found 159 articles, of which 55 were relevant; 20 of those were excluded because they used other blood conservation techniques in addition to cell salvage. Five articles were manually selected from reference lists. In total, 40 articles were reviewed. There is sufficient evidence of the clinical safety of using salvaged blood in oncological surgery. SBT decreases the risk of postoperative infections and tumour recurrence. However, there are some limitations regarding its clinical applications, as it cannot be employed in cases of sepsis. In this review, we established that earlier studies supported the use of salvaged blood from a cell saver in conjunction with a leukocyte depletion filter (LDF). Furthermore, we highlight the recent emergence of sufficient evidence supporting the use of intraoperative cell salvage without an LDF in MSTS.
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Nivetha Ravikumar
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Joel Yong Hao Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Kutbuddin Akbary
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Ravish Shammi Patel
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Rajesh Kannan
- Department of Anaesthesiology, National University Hospital, Singapore
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Mercuriali F, Inghilleri G. LA TRASFUSIONE DI SANGUE NELLA CHIRURGIA ONCOLOGICA: RUOLO DELLA ERITROPOIETINA RICOMBINANTE UMANA (rHuEPO). TUMORI JOURNAL 2018; 84:S3-14. [PMID: 10083889 DOI: 10.1177/03008916980846s102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anemia is common in cancer patients. The pathophysiology is multifactorial, however the most common cause is the anemia of chronic diseases (ACD). In 20-50% of cancer patients, anemia restricts physical activity and quality of life and requires transfusion support. The percentage of patients necessitating transfusion dramatically increases when patients require surgery. The traditional belief that blood transfusion is an effective and safe therapy has been challenged by a heightened awareness of the infectious and immunologic risks associated with allogeneic blood administration. In cancer patients transfusion-induced immunomodulation may have the potential to significantly increase postoperative infections and cancer recurrence so that it seems reasonable to minimize allogeneic blood exposure. Several strategies have been adopted to reduce allogeneic transfusion in surgical patients, however to properly select the appropriate blood conservation strategies the blood transfusion requirements for each patient should be defined. Allogeneic blood transfusion in surgery can be reduced by the introduction of autologous blood (AB) programmes and by the use of rHuEPO, alone or in association with AB techniques. AB donation is currently a standard of care for elective surgical patients but its efficacy is limited by anemia that prevents the donation of the optimal number of AB units. rHuEPO has been shown to significantly increase the volume of AB that anemic patients can predeposit or, used perisurgically, to expand the circulating RBCs mass before surgery. Moreover clinical trials employed rHuEPO in anemic cancer patients with various solid tumors both on and off chemotherapy reporting a significantly increase in Hct in more than 50% of the treated patients. Recently different studies have shown the efficacy of rHuEPO in increasing the volume of AB also in patients with ACD and cancer, thus proving to be a useful addition to existing strategies of blood conservation to minimize exposure to allogeneic blood in surgical cancer patients.
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Affiliation(s)
- F Mercuriali
- Servizio di Immunoematologia e Trasfusionale, Istituto Ortopedico Gaetano Pini, Milano
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Perez-Ferrer A, Gredilla-Díaz E, de Vicente-Sánchez J, Navarro-Suay R, Gilsanz-Rodríguez F. Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:185-191. [PMID: 28094033 DOI: 10.1016/j.redar.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. MATERIAL AND METHOD Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10μg/ml-1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. RESULTS Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl-1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31μg/ml-1 (95% CI 1.19 to 1.43; P=.074). CONCLUSIONS The addition of vancomycin at a concentration of 10ug/ml-1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases.
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Affiliation(s)
- A Perez-Ferrer
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Gredilla-Díaz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J de Vicente-Sánchez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - R Navarro-Suay
- Servicio de Anestesiología y Reanimación, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - F Gilsanz-Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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Zaw AS, Bangalore Kantharajanna S, Kumar N. Is Autologous Salvaged Blood a Viable Option for Patient Blood Management in Oncologic Surgery? Transfus Med Rev 2017; 31:56-61. [DOI: 10.1016/j.tmrv.2016.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/03/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
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Nitescu N, Bengtsson A, Bengtson JP. Blood salvage with a continuous autotransfusion system compared with a haemofiltration system. Perfusion 2016; 17:357-62. [PMID: 12243440 DOI: 10.1191/0267659102pf603oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Red blood cells may be destroyed by autotransfusion processing during intraoperative salvage. The aim of the present study was to evaluate the blood component recovery rate of techniques built on either continuous centrifugation and washing, or haemofiltration (HF). Methods: Two different methods used in blood salvage - red cell salvage with continuous processing with centrifugation and saline washing (Continuous Auto Transfusion System, CATS) and whole blood recirculation through a 30000-Da filter, i.e., HF - were compared in a randomized laboratory study using donor whole blood activated by cobra venom factor. The recovery of red blood cells, haemoglobin, free haemoglobin, leucocytes, platelets, albumin, total protein and potassium was measured. Results: The recovery of red cells was 86% with CATS and 76% with HF. HF had a significantly higher recovery of leucocytes (CATS 20%, HF 63%), platelets (CATS 4%, HF 37%), albumin (CATS 0.2%, HF 70%), total protein (CATS 1.3%, HF 71%) and potassium (CATS 2%, HF 17%). Less than 1% haemolysis was obtained in processed blood from both groups. Conclusion: Both methods caused little destruction of the red blood cells during processing. There was a larger reinfusion of leucocytes, platelets, albumin, total protein and extracellular potassium when HF was used compared with the ‘CATS’ method.
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Affiliation(s)
- N Nitescu
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Intra-operative cell salvage: a fresh look at the indications and contraindications. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:139-47. [PMID: 21251468 DOI: 10.2450/2011.0081-10] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 10/15/2010] [Indexed: 01/08/2023]
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Marković M, Davidović L, Savić N, Sindjelić R, Ille T, Dragaš M. Intraoperative Cell Salvage versus Allogeneic Transfusion during Abdominal Aortic Surgery: Clinical and Financial Outcomes. Vascular 2009; 17:83-92. [DOI: 10.2310/6670.2009.00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to assess the clinical and financial outcomes of intraoperative cell salvage (ICS) during abdominal aortic surgery. In this study, 90 patients were operated on with the use of ICS (group 1, prospective) and 90 patients without ICS (group 2, historical control). According to the type of operation, the patients were subdivided into three consecutive 30-patient subgroups (1, aortoiliac occlusive disease [AOD]; 2, elective abdominal aortic aneurysm [AAA]; or 3, ruptured abdominal aortic aneurysm [RAAA]). Transfusion requirements and postoperative complications were recorded. The total amounts of perioperatively transfused allogeneic blood were higher in all patient subgroups that underwent surgery without ICS ( p = .0032). In the ICS group, 50% of AOD patients and 60% of elective AAA patients received no allogeneic transfusions. There were no significant differences in the incidence of postoperative complications in any group examined. ICS significantly reduced the necessity for allogeneic transfusions during abdominal aortic surgery. ICS use was most valuable in urgent situations with high blood losses, such as RAAA, for which only small amounts of allogeneic blood were initially available. In patients with more than 3 units of autologous blood reinfused, this method was cost effective.
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Affiliation(s)
- Miroslav Marković
- *Clinic for Vascular Surgery, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia; †Institute for Medical Statistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Lazar Davidović
- *Clinic for Vascular Surgery, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia; †Institute for Medical Statistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Nebojša Savić
- *Clinic for Vascular Surgery, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia; †Institute for Medical Statistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Radomir Sindjelić
- *Clinic for Vascular Surgery, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia; †Institute for Medical Statistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Tatjana Ille
- *Clinic for Vascular Surgery, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia; †Institute for Medical Statistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Marko Dragaš
- *Clinic for Vascular Surgery, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia; †Institute for Medical Statistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
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Catling S, Williams S, Freites O, Rees M, Davies C, Hopkins L. Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood. Anaesthesia 2008; 63:1332-8. [PMID: 19032302 DOI: 10.1111/j.1365-2044.2008.05637.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SUMMARY The intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2/50 central venous samples, 34/50 reservoir samples and 31/50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.
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Futamura N, Nakanishi H, Hirose H, Nakamura S, Tatematsu M. The Effect of Storage on the Survival of Cancer Cells in Blood and Efficient Elimination of Contaminating Cancer Cells by a Leukocyte Depletion Filter. Am Surg 2005. [DOI: 10.1177/000313480507100710] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preoperative autologous blood pooling has been employed in patients with malignant tumor. However, it has not been reported how the survival period of tumor cells contaminating the preoperative pooled blood changes corresponding to the storage period. Intraoperative blood salvage (IBS) is used together with preoperative blood pooling. However, IBS in oncologic surgery is generally regarded as a contraindication. In the current study, using cytokeratin 19 (CK-19) mRNA reverse transcription polymerase chain reaction method, we examined the survival period of cultured cancer cells in the pooled blood and the efficacy of irradiation and leukocyte depletion filter in eliminating cancer cells in the blood. Expression of CK-19 mRNA was observed in the pooled blood stored for 21 days. The number of cancer cells decreased to about 1/10 in the blood stored for 14 days. We irradiated blood with cancer cells with doses of 25 Gy or 100 Gy. No change was observed in the amplified CK-19 signal strength immediately after and 1 day after irradiation at 100 Gy. After filtration of blood with cancer cells through the leukocyte depletion filter, no CK-19 mRNA was detected. Blood filtration with the leukocyte depletion filter was effective in eliminating cancer cells in the blood.
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Affiliation(s)
- Naoki Futamura
- Department of Advanced Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Hayao Nakanishi
- Division of Oncological Pathology, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Hajime Hirose
- Department of Advanced Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Shigeo Nakamura
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Masae Tatematsu
- Division of Oncological Pathology, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
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Affiliation(s)
- Jonathan H Waters
- Department of General Anesthesiology and Clinical Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Affiliation(s)
- Ernil Hansen
- Department of Anesthesiology, University of Regensburg, Regensburg, Germany.
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Wells PS. Safety and efficacy of methods for reducing perioperative allogeneic transfusion: a critical review of the literature. Am J Ther 2002; 9:377-88. [PMID: 12237729 DOI: 10.1097/00045391-200209000-00004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A number of pharmacologic and nonpharmacologic technologies are in current use to minimize perioperative homologous blood use. Clinical trials, many of them randomized controlled trials, have been done evaluating these approaches and have demonstrated their efficacy. However, data on safety has relied mostly on case reports, uncontrolled studies, and, for the pharmacologic agents, extrapolation from the nonsurgical setting. In this review I analyze the data from the randomized trials and the lower-level evidence studies to provide the best estimates in safety with these alternatives. In general, these alternatives are safe with proper dosing and monitoring of effects. With aprotinin, the primary concern is anaphylaxis, and this predominantly with re-exposure. With aprotinin and with the anti-fibrinolytics, increased venous thromboembolic risk has not been a consistent finding. Tranexamic acid use intraoperatively is advantageous, but postoperative use appears to have no advantage and may be associated with renal dysfunction. DDAVP is low-risk, provided it is not overused, which can induce hyponatremia. Autologous predonation probably has similar risks as homologous blood with respect to transfusion errors and bacterial infection. As with most medical interventions, we must be vigilant to prevent human error.
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Affiliation(s)
- Philip S Wells
- Department of Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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20
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Dehne MG, Mühling J, Sablotzki A, Nopens H, Hempelmann G. Pharmacokinetics of antibiotic prophylaxis in major orthopedic surgery and blood-saving techniques. Orthopedics 2001; 24:665-9. [PMID: 11478553 DOI: 10.3928/0147-7447-20010701-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The pharmacokinetics of cefuroxime, cefotiam, cefamandole, and ampicillin/sulbactam were randomly measured in 40 patients undergoing major orthopedic surgery associated with high blood and volume turnover and intraoperative blood salvage. Serum and bone concentrations and the pharmacokinetics occurring in the context of these procedures were measured. No changes in elimination half-life relative to a normal population occurred with cefuroxime, cefotiam, and ampicillin. Serum and tissue concentrations were slightly lower with cefamandole and sulbactam, but reapplication of the initial dose was required with all antibiotics 4 hours after the first application.
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Affiliation(s)
- M G Dehne
- Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University of Giessen, Germany
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21
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Krohn CD, Reikerås O, Bjørnsen S, Brosstad F. Fibrinolytic activity and postoperative salvaged untreated blood for autologous transfusion in major orthopaedic surgery. THE EUROPEAN JOURNAL OF SURGERY = ACTA CHIRURGICA 2001; 167:168-72. [PMID: 11316399 DOI: 10.1080/110241501750099276] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- C D Krohn
- National Hospital, Centre for Orthopaedics, Oslo, Norway
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22
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Orliaguet G, Dahmani S, Meyer P, Blanot S, Carli P. [Acute hemolysis following perioperative blood salvage in chldren operated for the surgical correction of craniosynostosis]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:28-31. [PMID: 11234574 DOI: 10.1016/s0750-7658(00)00323-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of a 6-month-old child, who suffered from acute haemolysis following transfusion of salvaged blood. This complication, of favourable outcome, was related to the accidental aspiration of benzalkonium chloride into the cell saver. This case emphasizes that any adjunction of antiseptic solution is contraindicated during blood saving. The use of a cell saver must be associated with written protocols, describing clearly the contraindications, precautions of use, and the different steps of use of this method of autologous blood transfusion.
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Affiliation(s)
- G Orliaguet
- Département d'anesthésie-réanimation chirurgicale, hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris, France.
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23
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Abstract
Abstract
The discovery of AIDS in the 1980s and its rapid evolution as a major concern for physicians and their patients have led to many questions about the safety of the blood supply. The attention placed on AIDS has led to new discoveries and technologies to reduce the risk of other transfusion complications such as hepatitis, bacterial contamination, and transfusion-associated graft-vs-host disease. Concerns about blood safety have focused much attention on alternative blood transfusion strategies such as autologous blood, viral inactivation, and artificial blood substitutes. This review describes the transfusion medicine delivery system in the United States, with special emphasis on evolving developments and their implications for the discipline of chemical pathology.
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Affiliation(s)
- Paul M Ness
- Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, and Greater Chesapeake and Potomac Region, American Red Cross Blood Services, Baltimore, MD
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24
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25
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Affiliation(s)
- P M Ness
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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26
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Hansen E, Knuechel R, Altmeppen J, Taeger K. Blood irradiation for intraoperative autotransfusion in cancer surgery: demonstration of efficient elimination of contaminating tumor cells. Transfusion 1999; 39:608-15. [PMID: 10378841 DOI: 10.1046/j.1537-2995.1999.39060608.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intraoperative blood salvage is contraindicated in cancer surgery because of contaminating tumor cells and the risk of systemic dissemination. On the basis of the radiosensitivity of cancer cells, irradiation of salvaged blood with 50 Gy is proposed as a way to allow return of salvaged blood. STUDY DESIGN AND METHODS Elimination of tumor cells by blood irradiation was studied in vitro with cells from 10 cell lines and from 14 tumor preparations after their addition to red cells in high numbers, or with blood shed during cancer surgery. Before and after gamma radiation, tumor cells were isolated by density gradient centrifugation and tested for their proliferative capacity in a cell colony assay. DNA metabolism was analyzed by incorporation of 5' bromodesoxyuridine. RESULTS Survival curves of cells from various tumors confirmed D0 (the dose required to reduce the fraction of surviving cells to 37 percent of the original value) values in the range of 1.2 to 2.2 Gy. After irradiation of tumor cell-contaminated blood with 50 Gy, no cell colony formation was observed, which indicates a reduction rate exceeding 10 log. Irradiated cancer cells showed viability, but no residual DNA metabolism. CONCLUSION The level of inactivation by a 50-Gy dose far exceeds that needed to inactivate the number of proliferating tumor cells observed or expected in wound blood. These results provide the experimental basis for the clinical application of blood irradiation for intraoperative blood salvage in cancer surgery.
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Affiliation(s)
- E Hansen
- Department of Anesthesiology, University of Regensburg, Germany.
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27
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Faught C, Wells P, Fergusson D, Laupacis A. Adverse effects of methods for minimizing perioperative allogeneic transfusion: a critical review of the literature. Transfus Med Rev 1998; 12:206-25. [PMID: 9673005 DOI: 10.1016/s0887-7963(98)80061-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- C Faught
- Department of Medicine, University of Ottawa, Ontario, Canada
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28
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29
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Bengtsson A, Bengtson JP. Autologous blood transfusion: preoperative blood collection and blood salvage techniques. Acta Anaesthesiol Scand 1996; 40:1041-56. [PMID: 8908218 DOI: 10.1111/j.1399-6576.1996.tb05622.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Bengtsson
- Department of Anaesthesiology & Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden
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30
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Affiliation(s)
- M J Lemos
- Department of Orthopaedic Surgery, Lahey Hitchcock Medical Center, Burlington, Massachusetts 01805, USA
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31
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Mercuriali F, Inghilleri G, Colotti MT, Farè M, Biffi E, Vinci A, Podico M, Scalamogna R. Bedside transfusion errors: analysis of 2 years' use of a system to monitor and prevent transfusion errors. Vox Sang 1996; 70:16-20. [PMID: 8928485 DOI: 10.1111/j.1423-0410.1996.tb00990.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Clerical errors occurring during specimen collection, issue and transfusion of blood are the most common cause of AB0 incompatible transfusions. 40-50% of the transfusion fatalities result from errors in properly identifying the patient or the blood components. The frequency and type of errors observed, despite the implementation of measures to prevent them, suggests that errors are inevitable unless major changes in procedures are adopted. A fail-safe system, which physically prevents the possibility of error, was adopted in January 1993 and concurrently a quality improvement program was implemented to monitor any transfusion errors. Up to December 1994, 10,995 blood units (5,057 autologous and 5,938 allogeneic) were transfused to 3,231 patients. Seventy-one methodological errors(1/155 units) were observed, half of which were concentrated during the first 4 months of introducing the system. However the system detected and avoided four potentially fatal errors (1/2,748 units). Two cases involved the interchanging of recipient sample tubes, 1 case was due to patient misidentification and the other involved misidentification of blood units. In conclusion the system is effective in detecting otherwise undiscovered errors in transfusion practice and can prevent potential transfusion-associated fatalities caused by misidentification of blood units or recipients.
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Affiliation(s)
- F Mercuriali
- Centro Trasfusionale e di Immunoematologia, Instituto Ortopedico G. Pini, Milano, Italy
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32
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Spence RK. Surgical red blood cell transfusion practice policies. Blood Management Practice Guidelines Conference. Am J Surg 1995; 170:3S-15S. [PMID: 8546244 DOI: 10.1016/s0002-9610(99)80052-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R K Spence
- Staten Island University Hospital, New York 10305, USA
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33
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Lefevre P. [Which technique should be chosen to reuse blood lost intraoperatively? Does the type of surgery constitute any contraindication for reutilization (cancer, infection)?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1995; 14 Suppl 1:53-62. [PMID: 7486319 DOI: 10.1016/s0750-7658(05)81805-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P Lefevre
- Service d'Hémaphérèse et d'Autotransfusion, Hôpital de la Conception, Marseille
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34
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Keipert PE. Use of Oxygent, a perfluorochemical-based oxygen carrier, as an alternative to intraoperative blood transfusion. ARTIFICIAL CELLS, BLOOD SUBSTITUTES, AND IMMOBILIZATION BIOTECHNOLOGY 1995; 23:381-94. [PMID: 7493059 DOI: 10.3109/10731199509117954] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oxygent is a stable concentrated perfluorochemical (PFC) emulsion being developed for use as a temporary oxygen carrier. In this application, PFC emulsions can be used to augment oxygen delivery during acute blood loss and thereby provide a margin of safety during hemodilution and surgical anemia. PFCs simply dissolve oxygen in direct proportion to its partial pressure. The oxygen transported by a PFC emulsion is present in the plasma compartment and is therefore easily extracted and consumed by the tissues. Preclinical and clinical studies have demonstrated that a relatively low dose (1.35 g PFC/kg) of Oxygent can support oxygen delivery despite ongoing blood loss. Clinical safety studies in 57 healthy, conscious volunteers and in 30 anesthetized surgical patients have been completed. In these studies, there were no hemodynamic changes or vasoconstriction and cardiac output increased normally in response to hemodilution. Two transient side effects were observed, but only in the high dose (1.8 g PFC/kg) group: a 1-1.5 degrees C increase in body temperature (at 4-6 hours), and a moderate decrease in platelet count (mean nadir approximately 130,000/microL by 2-3 days) without any bleeding complications. Oxygent is presently being evaluated as an alternative to allogeneic blood transfusion in patients undergoing medium- to high-blood-loss surgical procedures.
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Affiliation(s)
- P E Keipert
- Alliance Pharmaceutical Corp., San Diego, CA 92121, USA
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35
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36
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Abstract
In this survey of transfusion in surgery, we have attempted to provide the surgeon with an understanding of the problems associated with homologous transfusion and a practical knowledge of treatment strategies and alternatives designed to reduce homologous blood exposure. Such a review cannot be encyclopedic. Our hope is that it will serve the reader as a stimulus to examine his or her transfusion practices and as a guide for future self-learning.
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Affiliation(s)
- R K Spence
- Section of Vascular Surgery, Cooper Hospital-University Medical Center, Robert Wood Johnson Medical School, Camden, New Jersey
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37
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Blevins FT, Shaw B, Valeri CR, Kasser J, Hall J. Reinfusion of shed blood after orthopaedic procedures in children and adolescents. J Bone Joint Surg Am 1993; 75:363-71. [PMID: 8444914 DOI: 10.2106/00004623-199303000-00007] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A prospective study was done of the results of infusion of drained blood after major procedures on the spine and hip in twenty-six patients. The Solcotrans system was used to salvage drained blood in the first six hours after the operation. Transfusion requirements, blood loss, hematocrit, temperature, prothrombin time, partial prothrombin time, platelet count, results of blood cultures, and levels of factor VIII, factor V,D-dimer, antithrombin III, plasminogen, protein C, and complement C3a des arginine were determined for some or all of the patients. A mean of 375 milliliters of blood from the Solcotrans receptacle was reinfused. All of the cultures were negative. There were no febrile reactions. The mean values for the specimens of the salvaged blood were: hematocrit, 0.20; hemoglobin, seventy-one grams per liter; plasma hemoglobin, 2.36 grams per liter; C3a des arginine, 9.4 x 10(-3) grams per liter; fat particles of less than nine micrometers in diameter, 23,643 per milliliter; and D-dimer, 205 x 10(-3) grams per liter. Studies of blood samples that were collected from patients one to two hours and twelve to eighteen hours after the transfusion showed only slight increases in fibrin split products one hour after the transfusion; these values reverted to normal by eighteen hours. No clinical coagulopathy associated with reinfusion was observed. The reinfusion of unwashed, filtered shed blood that was as much as 15 per cent of the total blood volume proved to be a safe technique after major orthopaedic procedures.
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Affiliation(s)
- F T Blevins
- Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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38
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Abstract
Developing a quality perioperative autologous blood recovery program is a team effort. Members of transfusion committees, hospital blood bank personnel, OR staff members, and the members of the surgery committee are all possible sources of information. Your local blood center also may have literature or services that could be of assistance. Knowledge of current autologous transfusion alternatives will help nurses communicate with patients regarding transfusion therapy and will make nurses more valuable participants in the crucial decisions necessary to deliver optimal patient care in the perioperative period.
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Affiliation(s)
- G M Johnson
- American Red Cross, St Paul Regional Blood Services, Minn
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39
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Affiliation(s)
- James Isbister
- Department of HaematologyThe Royal North Shore Hospital of Sydney
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40
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Dzik WH. The preparation of platelet concentrates by the light-spin/hard-spin technique. TRANSFUSION SCIENCE 1990; 12:171-81. [PMID: 10149546 DOI: 10.1016/0955-3886(91)90126-n] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
For at least two decades the light-spin/hard-spin (LS/HS) method for preparation of platelet concentrates (PC) has been the standard of platelet support. With concern over the detrimental effects of platelet activation during component preparation and with increased recognition of the adverse consequences resulting from residual donor leukocytes in PC, new approaches to the production of PC have begun. This review addresses two aspects of the traditional LS/HS method of platelet preparation: platelet activation and residual leukocyte content. Studies of platelet activation are reviewed which focus on the second (hard-spin) centrifugation step during which pelleting of platelets occurs. Platelets studied immediately after the hard-spin exhibit evidence of alpha-granule release, expression of activation antigens, and decreased aggregation. There is a suggestion that some degree of reversal of platelet activation routinely occurs during the rest period following the hard-spin. The residual leukocyte content of PC prepared by the LS/HS method ranges from 10 7 to 10 9 leukocytes/unit. The residual donor leukocytes are predominantly lymphocytes and monocytes. Degeneration of residual donor leukocytes may release soluble cytokines resulting in febrile transfusion reactions. It remains controversial whether or not the cell-membrane fragments and microvesicles of degenerating donor leukocytes are capable of HLA allosensitization or viral transmission. Release of leukocyte elastase from degenerating leukocytes during platelet storage has been proposed as contributing to the platelet storage lesion. More research is needed to address the question of whether or not pre-storage leukocyte reduction during component preparation will result in improved PC. It appears likely that within the next few years radical changes will occur in the method of preparation of PC with the aim of providing the greatest degree of hemostatic effectiveness with the least toxicity to patients.
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Affiliation(s)
- W H Dzik
- Blood Bank and Tissue Typing Laboratory, Department of Pathology and Laboratory Medicine, New England Deaconness Hospital, and Department of Medicine, Harvard Medical School, Boston, MA 02115
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