Abstract
(1) Background: Cell salvage is highly recommended in orthopedic surgery to avoid allogeneic transfusions. Preparational steps during cell salvage may induce extracellular vesicle (EV) formation with potential thrombogenic activity. The purpose of our study was to assess the appearance of EVs at retransfusion. (2) Methods: After ethics committee approval and informed consent, blood was withdrawn from the autotransfusion system (Xtra, Sorin, Germany) of 23 patients undergoing joint arthroplasty. EVs were assessed by flow cytometry in two times centrifugated samples. EVs were stained with specific antibodies against cellular origins from platelets (CD41), myeloid cells (CD15), monocytes (CD14), and erythrocytes (CD235a). The measured events/µL in the flow cytometer were corrected to the number of EVs in the retransfusate. (3) Results: We measured low event rates of EVs from platelets and myeloid origin (<1 event/µL) and from monocytic origin (<2 events/µL). Mean event rates of 17,042 events/µL (range 12–81,164 events/µL) were found for EVs from red blood cells. (4) Conclusion: Retransfusate contains negligible amounts of potentially thrombogenic EVs from platelet and monocytic origin. Frequent EVs from erythrocytes may indicate red blood cell destruction and/or activation during autologous cell salvage. Further research is needed to investigate the clinical relevance of EVs from salvaged red blood cells.
Highlights
Major surgery may lead to severe bleeding, anemia, hypovolemia, and allogeneic transfusion requirements [1]
Randomized controlled trials and meta-analyses further confirm that autologous cell salvage reduces the need for perioperative allogeneic red blood cell (RBC) transfusions [2,3,4,5]
Guidelines from the European Society of Anesthesiology highly recommended the use of cell salvage, which is helpful for blood conservation in major cardiac and orthopedic surgery (GRADE 1B) [1]
Summary
Major surgery may lead to severe bleeding, anemia, hypovolemia, and allogeneic transfusion requirements [1]. Guidelines from the European Society of Anesthesiology highly recommended the use of cell salvage, which is helpful for blood conservation in major cardiac and orthopedic surgery (GRADE 1B) [1]. Allogeneic RBC preparation involves centrifugation and dissolution; eventual cell damage and/or activation result in extracellular vesicle (EV) formation [6]. The amount of EVs increases upon storage time as part of the RBC storage lesion [6] This phenomenon has been linked to transfusion-associated thromboembolic and inflammatory complications [7,8]. Similar to allogeneic RBC preparation, autologous cell salvage involves centrifugation and washing procedures which may activate and/or destroy the patient’s blood cells, resulting in the generation of cell-derived EVs. Considering the increasing clinical use of cell salvage and innovations in cell salvage technology, markers for cell damage can be helpful in defining quality and safety of retransfused blood. We assessed extracellular vesicles from autologous platelets (CD41), monocytes (CD14) and myeloid cell origin (CD15), and erythrocytes (CD235a) using flow cytometry in a last-generation cell saver during orthopedic surgery
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