Intraoperative Blood Salvage in Bacterial Contaminated Surgical Site – an in vitro Study

Abstract

Cell saving and autogenic retransfusion is a wellestablished procedure in orthopedic, cardiac and abdominalsurgery. But it is contraindicated at a bacterially contaminatedsurgical site such as the oral cavity. Materials and Methods: In2003 and 2004 a clinically oriented in vitro study was processedin 45 enlarged operations for dysgnathia to recycle the intraoperativelycollected blood contaminated with microrganisms ofthe oral cavity. Cell salvage, leukocyte depletion, antimicrobialmedical treatment, and a selective endotoxin adsorption wereused as single cleaning procedures. Hematological, coagulative,immunologic and microbiological examinations were carriedout, including the measurement of endotoxin before, duringand after the procedure. In addition, the individual cleaningsteps were changed in their succession to determine the mosteffective one. Results: Already cell salvage and leukocyte depletioncould eliminate a considerable part of the oral cavitygerms. However, only extracorporeal addition of antibiotic andantimycotic agents guaranteed a reproducible bacterial removal.Endotoxin could be eliminated up to 99.9 ± 0.1% by allpurification steps, including a specific endotoxin adsorber. Atthe end of all procedures hematocrit was increased by a renewedwashing centrifugation. The hemolysis rate at the endwas 0.2 ± 0.1%. Cytokines and fibrin degradation products wereeliminated by more than 90%. Because of the multistage purificationprocedure, 50% of intraoperative blood loss could becompensated. Conclusion: The combination of cell salvage,leukocyte depletion, antimicrobial medical treatment and selectiveendotoxin adsorption allows for the production of autogenicred blood cell concentrates free of germs, saliva and endotoxinalso from a bacterially contaminated surgical site.