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Wu Y, He J, Han X, Xu Q, Dai H, Wu J. Application of an autotransfusion pressure control system in blood salvage. J Int Med Res 2023; 51:3000605231206963. [PMID: 38017365 PMCID: PMC10686018 DOI: 10.1177/03000605231206963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/25/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE This study was performed to evaluate the effect of a homemade autotransfusion pressure-control system on the regulation of negative pressure and to clarify the influence of different negative pressures on the recovered erythrocytes. METHODS Fifty patients were randomly divided into five groups, and five different suction-generated negative pressures were applied. Before suction, 6 mL of blood was collected from the surgical field; after suction, 6 mL of blood was collected from the blood storage tank. The hemoglobin, hematocrit, mean corpuscular volume, newly generated standardized plasma free hemoglobin, and change in the hemolysis rate of erythrocytes before and after suction were compared. Additionally, the erythrocyte morphology was observed. RESULTS The hemoglobin and hematocrit were significantly different before and after suction in all five groups. As the suction pressure increased, gradual increases were noted in the number of abnormal erythrocytes in the field of view, the newly generated standardized plasma free hemoglobin, and the change in the hemolysis rate. CONCLUSIONS The destruction rate of erythrocytes increased as the suction-generated negative pressure increased. When using a pressure-control system, a negative pressure of <200 mmHg should be applied to reduce the damage to the autotransfused blood.
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Affiliation(s)
- Yini Wu
- Department of Anesthesiology, People’s Hospital of Lishui, Lishui, Zhejiang, China
| | - Jiaqun He
- Department of Anesthesiology, People’s Hospital of Haiyan, Haiyan, Zhejiang, China
| | - Xin Han
- Department of Anesthesiology, People’s Hospital of Lishui, Lishui, Zhejiang, China
| | - Qiaomin Xu
- Department of Anesthesiology, People’s Hospital of Lishui, Lishui, Zhejiang, China
| | - Hong Dai
- Department of Anesthesiology, People’s Hospital of Lishui, Lishui, Zhejiang, China
| | - Jimin Wu
- Department of Anesthesiology, People’s Hospital of Lishui, Lishui, Zhejiang, China
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Rajendran L, Lenet T, Shorr R, Abou Khalil J, Bertens KA, Balaa FK, Martel G. Should Cell Salvage Be Used in Liver Resection and Transplantation? A Systematic Review and Meta-analysis. Ann Surg 2023; 277:456-468. [PMID: 35861339 PMCID: PMC9891298 DOI: 10.1097/sla.0000000000005612] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the effect of intraoperative blood cell salvage and autotransfusion (IBSA) use on red blood cell (RBC) transfusion and postoperative outcomes in liver surgery. BACKGROUND Intraoperative RBC transfusions are common in liver surgery and associated with increased morbidity. IBSA can be utilized to minimize allogeneic transfusion. A theoretical risk of cancer dissemination has limited IBSA adoption in oncologic surgery. METHODS Electronic databases were searched from inception until May 2021. All studies comparing IBSA use with control in liver surgery were included. Screening, data extraction, and risk of bias assessment were conducted independently, in duplicate. The primary outcome was intraoperative allogeneic RBC transfusion (proportion of patients and volume of blood transfused). Core secondary outcomes included: overall survival and disease-free survival, transfusion-related complications, length of hospital stay, and hospitalization costs. Data from transplant and resection studies were analyzed separately. Random effects models were used for meta-analysis. RESULTS Twenty-one observational studies were included (16 transplant, 5 resection, n=3433 patients). Seventeen studies incorporated oncologic indications. In transplant, IBSA was associated with decreased allogeneic RBC transfusion [mean difference -1.81, 95% confidence interval (-3.22, -0.40), P =0.01, I 2 =86%, very-low certainty]. Few resection studies reported on transfusion for meta-analysis. No significant difference existed in overall survival or disease-free survival in liver transplant [hazard ratio (HR)=1.12 (0.75, 1.68), P =0.59, I 2 =0%; HR=0.93 (0.57, 1.48), P =0.75, I 2 =0%] and liver resection [HR=0.69 (0.45, 1.05), P =0.08, I 2 =0%; HR=0.93 (0.59, 1.45), P =0.74, I 2 =0%]. CONCLUSION IBSA may reduce intraoperative allogeneic RBC transfusion without compromising oncologic outcomes. The current evidence base is limited in size and quality, and high-quality randomized controlled trials are needed.
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Affiliation(s)
- Luckshi Rajendran
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Tori Lenet
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jad Abou Khalil
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Kimberly A. Bertens
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Fady K. Balaa
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Guillaume Martel
- Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Gama JVP, Ferreira RM, Lima LP, Neves TR, Dias JPG, Sousa Filho GDD. THE USE OF AUTOLOGOUS BLOOD TRANSFUSION IN DIGESTIVE TRACT SURGERY: A LITERATURE REVIEW. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:137-143. [PMID: 37194772 DOI: 10.1590/s0004-2803.202301000-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/14/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND The use of autologous blood transfusion in digestive tract surgeries, whether after preoperative blood collection or intraoperative blood salvage, is an alternative to allogeneic blood, which brings with it certain risks and shortage, due to the lack of donors. Studies have shown lower mortality and longer survival associated with autologous blood, however the theoretical possibility of spreading metastatic disease is still one of the limiting factors of its use. OBJECTIVE To evaluate the application of autologous transfusion in digestive tract surgeries, noting the benefits, damages and effects on the spread of metastatic disease. METHODS This is an integrative review of the literature available in the PubMed, Virtual Health Library and SciELO databases, by searching for "Autologous Blood Transfusion AND Gastrointestinal Surgical Procedures". Observational and experimental studies and guidelines published in the last five years in Portuguese, English or Spanish were included. RESULTS Not all patients benefit from blood collection before elective procedures, with the time of surgery and hemoglobin levels some of the factors that may indicate the need for preoperative storage. Regarding the intraoperative salvaged blood, it was observed that there is no increased risk of tumor recurrence, but the importance of using leukocyte filters and blood irradiation is highlighted. There was no consensus among the studies whether there is a maintenance or reduction of complication rates compared to allogeneic blood. The cost related to the use of autologous blood may be higher, and the less stringent selection criteria prevent it from being added to the general donation pool. CONCLUSION There were no objective and concordant answers among the studies, but the strong evidence of less recurrence of digestive tumors, the possibility of changes in morbidity and mortality, and the reduction of costs with patients suggest that the practice of autologous blood transfusion should be encouraged in digestive tract surgeries. It is necessary to note if the deleterious effects would stand out amidst the possible benefits to the patient and to health care systems.
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Affiliation(s)
- João Vitor Ponciano Gama
- Universidade de Vassouras, Pró-Reitoria de Ciências Médicas, Vassouras, RJ, Brasil
- Colégio Brasileiro de Cirurgia Digestiva, São Paulo, SP, Brasil
| | - Rian Magro Ferreira
- Universidade de Vassouras, Pró-Reitoria de Ciências Médicas, Vassouras, RJ, Brasil
| | | | | | | | - Gilvando Dias de Sousa Filho
- Hospital Universitário de Vassouras, Vassouras, RJ, Brasil
- Colégio Brasileiro de Cirurgiões, Rio de Janeiro, RJ, Brasil
- Associação Brasileira de Transplante de Órgãos, São Paulo, SP, Brasil
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Aziz H, Genyk Y, Saif MW, Filkins A, Selby R, Sheikh MR. Review of Oncology and Transplant Literature for the Management of Hepatic and Pancreatic Resections in Jehovah's Witnesses. CANCER MEDICINE JOURNAL 2021; 4:16-26. [PMID: 32601622 PMCID: PMC7324029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Jehovah's Witnesses undergoing liver or pancreas surgery represent a unique medical and ethical challenge. For hepatic and pancreatic malignancies, resections are currently the only curative treatment. These surgeries pose a risk for significant blood loss, for which blood transfusions are traditionally given. However, blood transfusions are considered unacceptable to many Jehovah's Witnesses patients. As the technology of surgery as well as development of new products continue to evolve, transfusion-less surgery modalities have been utilized for Jehovah's Witnesses. The use of these transfusion-less techniques is not yet standardized for hepatic and pancreatic resections. We aimed to review both oncology and transplant medical literature on pancreatic and hepatic resection to develop guidelines for the management Jehovah's Witnesses patients.
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Affiliation(s)
- Hassan Aziz
- Hepatobiliary, pancreas, and Abdominal Transplant, Keck Hospital of University of Southern California, USA
| | - Yuri Genyk
- Hepatobiliary, pancreas, and Abdominal Transplant, Keck Hospital of University of Southern California, USA
| | | | - Alexandra Filkins
- Hepatobiliary, pancreas, and Abdominal Transplant, Keck Hospital of University of Southern California, USA
| | - Rick Selby
- Hepatobiliary, pancreas, and Abdominal Transplant, Keck Hospital of University of Southern California, USA
| | - Mohd Raashid Sheikh
- Hepatobiliary, pancreas, and Abdominal Transplant, Keck Hospital of University of Southern California, USA
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Ivanics T, Shubert CR, Muaddi H, Claasen MPAW, Yoon P, Hansen BE, McCluskey SA, Sapisochin G. Blood Cell Salvage and Autotransfusion Does Not Worsen Oncologic Outcomes Following Liver Transplantation with Incidental Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. Ann Surg Oncol 2021; 28:6816-6825. [PMID: 33778907 DOI: 10.1245/s10434-021-09863-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative blood cell salvage and autotransfusion (IBSA) during liver transplantation (LT) for hepatocellular carcinoma (HCC) is controversial for concern regarding adversely impacting oncologic outcomes. OBJECTIVE We aimed to evaluate the long-term oncologic outcomes of patients who underwent LT with incidentally discovered HCC who received IBSA compared with those who did not receive IBSA. METHODS Patients undergoing LT (January 2001-October 2018) with incidental HCC on explant pathology were retrospectively identified. A 1:1 propensity score matching (PSM) was performed. HCC recurrence and patient survival were compared. Kaplan-Meier survival analyses were performed, and univariable Cox proportional hazard analyses were performed for risks of recurrence and death. RESULTS Overall, 110 patients were identified (IBSA, n = 76 [69.1%]; non-IBSA, n = 34 [30.9%]). Before matching, the groups were similar in terms of demographics, transplant, and tumor characteristics. Overall survival was similar for IBSA and non-IBSA at 1, 3, and 5 years (96.0%, 88.4%, 83.0% vs. 97.1%, 91.1%, 87.8%, respectively; p = 0.79). Similarly, the recurrence rate at 1, 3, and 5 years was not statistically different (IBSA 0%, 1.8%, 1.8% vs. non-IBSA 0%, 3.2%, 3.2%, respectively; p = 0.55). After 1:1 matching (26 IBSA, 26 non-IBSA), Cox proportional hazard analysis demonstrated similar risk of death and recurrence between the groups (IBSA hazard ratio [HR] of death 1.26, 95% confidence interval [CI] 0.52-3.05, p = 0.61; and HR of recurrence 2.64, 95% CI 0.28-25.30, p = 0.40). CONCLUSIONS IBSA does not appear to adversely impact oncologic outcomes in patients undergoing LT with incidental HCC. This evidence further supports the need for randomized trials evaluating the impact of IBSA use in LT for HCC.
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Affiliation(s)
- Tommy Ivanics
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Christopher R Shubert
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hala Muaddi
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marco P A W Claasen
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Yoon
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bettina E Hansen
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Stuart A McCluskey
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, Canada. .,Division of General Surgery, University Health Network, Toronto, ON, Canada.
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Zeng J, Zhang S, Wu Q, Li S, Chen Y, Wu B. Effects of transfusion load and suction pressure on renal function in intraoperative salvage autotransfusion. ACTA ACUST UNITED AC 2021; 54:e10292. [PMID: 33470391 PMCID: PMC7812910 DOI: 10.1590/1414-431x202010292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/28/2020] [Indexed: 11/22/2022]
Abstract
Although some investigations have been performed to determine the effects of transfusion load and suction pressure on renal function during intraoperative salvage autotransfusion, the precise threshold is still undetermined. A total of 625 patients undergoing surgery with the Continuous AutoTransfusion System (CATSplus) were enrolled and divided into groups according to the utilized suction pressure and transfusion volume. Plasma free hemoglobin (FHB) and creatinine clearance (CCr) were assayed to indicate the renal function. Both 0.03 MPa suction (≥4-unit load) and >5 units transfusion changed the levels of FHB and CCr significantly when measured 24 h post-operation compared to pre-operation. Under 0.02 MPa suction (≥4-unit load), the alteration of FHB and CCr returned to normal after 24 h. Under 3 units transfusion, the levels of FHB and CCr at 6 and 12 h post-operation changed significantly compared to pre-operation (P<0.05 or P<0.01, respectively), and this alteration could be restored to normal at 72 h post-operation. After an exhaustive investigation, less than 4 units transfusion and less than 0.03 MPa suction pressure are recommended for intraoperative salvage autotransfusion.
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Affiliation(s)
- Jingyang Zeng
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Sijie Zhang
- Graduate School of Fujian Medical University, Fuzhou, Fujian, China
| | - Qilin Wu
- Graduate School of Fujian Medical University, Fuzhou, Fujian, China
| | - Shunyuan Li
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Yingle Chen
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Biyu Wu
- Department of Nursing, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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Yuan Y, Zhang Y, Shen L, Xu L, Huang Y. Perioperative Allogeneic Red Blood Cell Transfusion and Wound Infections: An Observational Study. Anesth Analg 2020; 131:1573-1581. [PMID: 33079881 DOI: 10.1213/ane.0000000000005122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND It remains unclear whether the benefits of performing perioperative allogeneic red blood cell (RBC) transfusion outweigh the risks of postoperative wound infection. The aim of this study was to assess the impact of perioperative RBC transfusion as well as dose-response relationship on wound infections in surgical patients in a large cohort. METHODS As a retrospective observational study, the national Hospital Quality Monitoring System database was used to retrieve information about in-hospital surgical patients without limitations on surgical types in the People's Republic of China between 2013 and 2018. Patients were divided into the perioperative RBC transfusion and non-RBC transfusion groups, and wound infection rates (the primary end point) were compared. Secondary end points included in-hospital mortality, nosocomial infections, and length of hospital stay. Furthermore, patients who underwent RBC transfusion were subdivided into 6 groups based on the volume of transfused RBCs to investigate the dose-response relationship between RBC transfusions and wound infections. The association between RBC transfusion and patient outcomes were analyzed using multivariable logistic regression models adjusted for potential confounders. RESULTS A total of 1,896,584 patients from 29 provinces were included, among whom 76,078 (4.0%) underwent RBC transfusions; the overall wound infection rate was 0.7%. After adjusting for confounding factors, perioperative RBC transfusion was associated with higher odds of wound infection (odds ratio [OR] = 2.24, 95% confidence interval [CI], 2.09-2.40; P < .001). As the volume of transfused RBCs increased, so did the odds of wound infection with a clear dose-response relationship (OR of >0 and ≤1 U, >1 and ≤2 U, >2 and ≤4 U, >4 and ≤8 U, >8 U transfusion compared with no RBC transfusion were 1.20, 95% CI, 0.76-1.91; 1.27, 95% CI, 1.10-1.47; 1.70, 95% CI, 1.49-1.93; 2.12, 95% CI, 1.83-2.45 and 3.65, 95% CI, 3.13-4.25, respectively). RBC transfusion was also found to be associated with higher odds of in-hospital mortality, nosocomial infection, and longer hospital stay. CONCLUSIONS RBC transfusion was associated with an increased odd of postoperative wound infection in surgical patients, and a significant dose-related relationship was also observed. While there are still essential confounders not adjusted for and the results do not necessarily indicate a causal relationship, we still recommend to lessen perioperative blood loss and optimize blood conservation strategies.
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Affiliation(s)
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Shen
- From the Department of Anesthesiology and
| | - Li Xu
- From the Department of Anesthesiology and
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Central hepatectomy for hepatocellular carcinoma in a patient with anti-Gerbich antibody. Surg Case Rep 2020; 6:131. [PMID: 32533269 PMCID: PMC7292842 DOI: 10.1186/s40792-020-00898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Anti-Gerbich (Ge) alloantibody against high-frequency erythrocyte antigen is extremely rare. Owing to incomplete evidence regarding the degree and severity of adverse events induced by hemolytic transfusion reactions, the transfusion management often remains cumbersome in these patients. We report an anti-Ge alloantibody positive patient with hepatocellular carcinoma (HCC) who underwent central hepatectomy (CH) without the need for an allogeneic blood transfusion. Case presentation A 76-year-old Japanese woman was diagnosed with HCC measuring 9.5 × 8.0 cm in segments 4, 5, and 8 of the liver. This patient with anti-Ge alloantibody had a history of two pregnancies without transfusion. CH was planned, and based on the suggestion from the multidisciplinary team meeting, preoperative autologous donation (PAD) and acute normovolemic hemodilution (ANH) were performed. CH was successfully performed by using CUSA and Thunderbeat® with Pringle maneuver and infra-hepatic inferior vena cava clamping without perioperative need for an allogeneic blood transfusion. She has been alive without recurrence after a follow-up period of 45 months. Conclusion To our knowledge, this is the first case report of hepatectomy in a patient with anti-Ge alloantibody. A multidisciplinary team approach, PAD and ANH, and bloodless liver surgical techniques appear to be useful for major hepatectomy in patients with extremely rare blood type.
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