Merkel KR, Lin SD, Frank SM, Kajstura TJ, Cruz NC, Lo BD, Black JH, Gehrie EA, Hensley NB, Cho BC, Lester LC. Balancing the Blood Component Transfusion Ratio for High- and Ultra High-Dose Cell Salvage Cases.
J Cardiothorac Vasc Anesth 2020;
35:1060-1066. [PMID:
32928652 DOI:
10.1053/j.jvca.2020.08.044]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
To assess the ratio of non-red blood cell to red blood cell components required to avoid coagulopathy when transfusing large amounts of salvaged blood using laboratory test-guided therapy.
DESIGN
Retrospective cohort study.
SETTING
Single-center, academic hospital.
PARTICIPANTS
Thoracoabdominal and abdominal open aortic surgery patients.
MEASUREMENT AND MAIN RESULTS
Thirty-eight patients in whom at least 1,000 mL of salvaged red blood cells were transfused were identified and divided into the following 2 cohorts: 1,000-to-2,000 mL of salvaged red blood cells (high dose) (n = 20) and >2,000 mL of salvaged red blood cells (ultra-high dose) (n = 18). Compared with the high-dose cohort, the ultra high-dose cohort received ∼4 times more salvaged red blood cells (1,240 ± 279 mL v 5,550 ± 3,801 mL). With transfusion therapy guided by intraoperative coagulation tests and thromboelastography, the adjusted ratio of non-red blood cell to red blood cell components (plasma + platelets + cryoprecipitate:allogeneic + salvaged red blood cells) was 0.59 ± 0.66 in the high-dose and 0.93 ± 0.27 in the ultra high-dose cohorts. Multiple coagulation parameters were normal and similar between cohorts at the end of surgery, as determined by the mean, median, and 95% confidence intervals.
CONCLUSIONS
When transfusing large volumes of salvaged blood, it is important to balance the ratio between non-red blood cell and red blood cell components. Through a laboratory test-guided approach, coagulopathy was not detected when transfusing blood in ratios of approximately 1:2 for patients receiving 1,000-to-2,000 mL of salvaged blood and 1:1 for patients receiving >2,000 mL of salvaged blood.
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