Allogeneic Transfusion Volume Research Articles

Does Autologous Transfusion Decrease Allogeneic Transfusion in Liposuction Surgery of Lymphedema Patients?

Background and ObjectiveLiposuction is an effective treatment for fat disposition in lymphedema. Blood transfusion has been seldom investigated in lymphedema liposuction surgery. The purpose of the study was to analyze clinical factors associated with blood transfusion in liposuction surgery of lymphedema patients and compare the autologous and allogeneic transfusion patterns.MethodsA total of 1,187 cases of liposuction due to lymphedema were recruited. Demographic, laboratory tests and operation information were collected. Patients were divided into a transfusion and a non-transfusion group. Different transfusion patterns were compared and analyzed.ResultsBetween the two groups, there is a significant difference in postoperative hemoglobin levels, and as well as gender, age, surgery duration, body weight change, intraoperative transfusion volume and blood loss, hospital length of stay, and surgical site distribution. There is a significant difference in the comparison of hospital stay length, autologous transfusion volume, combined allogeneic volume, operative blood loss, intraoperative transfusion volume, and change in hemoglobin levels between predonation and acute normovolemic hemodilution (ANH) transfusion. In comparison with the allogeneic transfusion-only patients, the mean allogeneic transfusion volume in either ANH group, predonated transfusion group, or mixed group is statistically lower. Allogeneic transfusion volume in the predonated-only group is significantly lower than that of either the ANH-only group or the mixing ANH with predonation group. Ordinary least squares regression analysis suggests that autologous transfusion in the ANH-only mode is statistically associated with allogeneic transfusion.ConclusionsThis study described the blood transfusion in lymphedema liposuction surgery and compared autologous and allogeneic transfusion patterns in these patients. Autologous transfusion can reduce the transfusion volume of allogeneic blood and might be a beneficial mode of transfusion in these patients.

Perioperative anaesthesia and coagulation management of haemophilia patients receiving total hip and knee replacement arthroplasty: Experience from a case series.

To report 13 consecutive cases of successful triad of anaesthesia, blood and coagulation management (ABC protocol) in haemophilic total joint arthroplasty (TJA) and its feasibility and safety on haemophilic TJA. All the clinical data of 13 consecutive cases were descend from electronic medical record. Patients who suffered from haemophilia A, undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) with ABC protocol at the academic hospital from December 2014 to November 2018 were included, and demographic, perioperative characteristics according to the classified method were further analysed. All 13 haemophilic patients had undergone successful surgery with ABC protocol. No massive blood loss was observed in perioperative period. The mean external blood loss was 876.92 ± 592.86 mL. The mean change in haemoglobin was 5.42 ± 2.43 g dL-1 at 5 days post-operatively. The mean allogeneic transfusion volume was 1.23 ± 1.35 units, and the mean volume of autotransfusion was 237.5 ± 76.93 mL. The average clotting factor consumption for per operated joint was 458.26 ± 226.45 IU kg-1 in all cases. No severe perioperative complications were occurred. ABC-related series of measures were appropriate management mode for patients received THA and/or TKA with mild or moderate haemophilia. However, more robust evidence came from larger samples is needed.

Application of apheresis autologous red blood cell transfusion in total hip arthroplasty

Objective To investigate the application of apheresis autologous red blood cell transfusion technology in total hip arthroplasty (THA). Methods From February to July 2016, a total of 191 patients who received THA treatment in the Chinese PLA General Hospital were selected as the research subjects. All patients were randomly divided into study group (n=91) and control group (n=100) by simple random sampling method. Patients in the study group received autologous red blood cell apheresis before THA, while the control group did not collect any autologous blood before THA. The main blood indicators, including red blood cell count, levels of hemoglobin (Hb), white blood cell count, platelet count, were recorded before apheresis in study group or before THA in control group, as well as on the 1st and 3rd day after THA in the 2 groups, respectively. The amount of blood loss during THA, allogeneic transfusion volume on the day of THA, allogeneic blood transfusion rate, allogeneic red blood cell transfusion volume, allogeneic red blood cell transfusion rate, allogeneic plasma transfusion volume, and allogeneic plasma transfusion rate were also observed. Mann-Whitney U test, Wilcoxon signed rank test or χ2 test were used to compare the difference of the above indications between the patients of 2 groups. The procedure of this study is in accordance with the requirements of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from each patient. Results ① In this study, there were no statistically significant differences in median red blood cell count of patients between study group before apheresis and that of control group before THA, as well as those of patients between the 2 groups on the 1st and 3rd day after THA (P>0.05). In study group, the median red blood cell count of patients before apheresis was higher than that of patients on the 1st and 3rd day after THA, and the differences were statistically significant (4.5×1012/L vs 4.1×1012/L, Z=-4.043, P 0.05). On the 1st day after THA, the median Hb level of patients in study group was 125 g/L (113-134 g/L), which was higher than 115 g/L (107-135 g/L) of patients in control group, and the difference was statistically significant (Z=-2.302, P=0.021). In study group, the median Hb level of patients before apheresis was higher than those of patients on the 1st and 3rd day after THA, and the differences were statistically significant (137 g/L vs 125 g/L, Z=-6.668, P 0.05). On the 1st day after THA, the median white blood cell count of patients in study group was 11.34×109/L (9.75×109/L-12.76×109/L), which was higher than 10.20×109/L (8.50×109/L-12.39×109/L) in control group, and the difference was statistically significant (Z=-2.399, P=0.016). In study group, the median white blood cell count of patients on the 1st day after THA was higher than those of patients before THA and on the 3rd day after THA, and the differences were statistically significant (11.34×109/L vs 6.15×109/L, Z=-8.272, P 0.05). In study group, the median platelet count of patients before apheresis was higher than those of patients on the 1st and 3rd day after THA, and the differences were statistically significant (229×109/L vs 183×109/L, Z=-7.796, P 0.05). The median volume of allogeneic blood transfusion of patients in study group was 2.6 U (1.0-4.4 U), which was lower than 5.3 U (3.0-7.2 U) of patients in control group, and the difference was statistically significant (Z=-3.903, P 0.05). The rate of allogenic red blood cell transfusion of patients in study group was 52.7%, which was lower than 82.0% of patients in control group, with a statistically significant difference (χ2=18.756, P<0.001). Conclusions The apheresis autologous red blood cell transfusion could meet the needs of clinical blood transfusion in patients with THA, which is safe and effective, and could be promoted during surgery. Key words: Blood transfusion, autologous; Arthroplasty, replacement, hip; Blood component transfusion; Apheresis autologous red blood cell; Autologous blood

Cell Saver for Adult Spinal Deformity Surgery Reduces Cost

Study DesignRetrospective cohort. ObjectivesTo determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery. Summary of Background DataRecent studies have questioned the clinical value of cell saver during spine procedures. MethodsASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group). ResultsThere were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009).Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient. ConclusionCompared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422. Level of EvidenceLevel III.

Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion.

Objective To evaluate the effect of point-of-care hemoglobin/hematocrit (POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice.Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference.Results In the hospitals where POC HGB/HCT device was used (n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011 (39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased (n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow.Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.

The Efficacy and Safety of Autologous Transfusion in Unilateral Total Knee Arthroplasty.

PurposeAlthough allogeneic blood transfusion is the most common method of transfusion in total knee arthroplasty (TKA), there are reports showing significant decrease in the amount of allogeneic transfusion and incidence of side effects after combined use of autologous transfusion. The purpose of this study is to investigate the efficacy of using an autologous transfusion device in TKA.Materials and MethodsPatients who underwent TKA at our institution from January 2003 to January 2014 were divided into two groups: group A (n=127) who received allogeneic transfusion only in TKA and group B (n=118) who received autologous transfusion via an autologous transfusion device and allogeneic transfusion. In both groups, the patients were transfused when the hemoglobin level was below 9 g/dL. In group B, blood collected by the autologous transfusion device was transfused only once after surgery. The total blood loss volume, total transfusion volume, and the presence of side effects were assessed based on medical records.ResultsGroup A received 294.6 mL more allogeneic transfusion than group B (p<0.001). There were no significant differences with regard to the development of side effects between groups.ConclusionsApplication of an autologous transfusion device during TKA can be effective in reducing the allogeneic transfusion volume. Moreover, allogeneic transfusion was not necessary after autologous transfusion in some patients.

Effect of Injecting Tranexamic Acid from a Drain to the Joint and Drain-Clamping to Reduce Blood Loss during Bilateral Cementless Total Knee Arthroplasty

Abstract Purpose: Our purpose was to clarify the effect of immediately postoperatively injecting tranexamic acid (TA) to the knee joint and drain clamping on reducing postoperative bleeding. Allogeneic blood transfusion requirement after bilateral cementless total knee arthroplasty (TKA) was also evaluated. Methods: This nonrandomized, retrospective study included 50 patients who underwent simultaneous bilateral primary cementless TKA. They were equally divided into a study group given an injection of TA (1000 mg) from drain to knee joint and drain clamping postoperatively (study group) and a control group who did not undergo this treatment. Postoperative total blood loss, drainage volume, hemoglobin level and transfusion amounts/rates were recorded. Results: Total blood loss, total drainage, and mean allogeneic transfusion volume and rate were lower in the study group than in controls (P<0.05). Hemoglobin level on postoperative day (POD) 14 was similar in the two groups but was higher in the study group on PODs 1 and 7 (P<0.05). Conclusions: Injection of TA from drain to knee joint and drain clamping at the end of the operation effectively reduced blood loss and allogeneic blood transfusion after bilateral cementless TKA.

The Association Between Perioperative Allogeneic Transfusion Volume and Postoperative Infection in Patients Following Lumbar Spine Surgery

Perioperative allogeneic red blood cell transfusion is a risk factor for surgical site infection. The purpose of this study was to determine if the volume of perioperative allogeneic red blood cell transfusion influences the risk of surgical site infection following lumbar spine procedures. A retrospective matched case control study was performed by reviewing all patients who had undergone lumbar spine surgery at our institution from 2005 to 2009. Surgical site infections (spinal or iliac crest) were identified, all within thirty days of the procedure. Controls were matched to the infection cohort according to age, sex, body mass index, diabetic status, smoking status, Charlson Comorbidity Index, length of surgery, and procedure. A conditional logistic regression was performed to examine the association between transfusion volume and surgical site infection. The results were summarized by an odds ratio. A total of 1799 lumbar procedures were identified with an infection rate of 3.1% (fifty-six cases). On the basis of the numbers, there was no significant difference in the matched variables between the infection cohort and the matched controls. The volume of transfusion was significantly associated with surgical site infection (odds ratio, 4.00 [95% confidence interval, 1.96 to 8.15]) after adjusting for both unmatched variables of preoperative hemoglobin level and volume of intraoperative blood loss. In this retrospective matched case control study, the association between surgical site infection following lumbar spine surgery and volume of perioperative allogeneic red blood cell transfusion was supported.

The Effect of Autotransfusion System in Minimally Invasive Total Knee Arthroplasty

PurposeTo evaluate the effect of autotransfusion system in minimally invasive total knee arthroplasty (TKA).Materials and MethodsSeventy-one patients who underwent unilateral minimally invasive TKA between October 2009 and June 2010 were selected. The first group included 36 patients who received standard vacuum drainage and the second group, 35 patients who underwent autologous retransfusion drainage. In the first group, allogeneic blood transfusion was performed if the postoperative hemoglobin level was <7.0 g/dL or 7.0-8.0 g/dL with the presence of a medical complication and an anemic symptom. The second group received autotransfusion and allogeneic transfusion additionally according to the same criteria. Changes in the pre- and postoperative hemoglobin level, amount of auto- or allotransfusion, and frequency of allogeneic transfusion were assessed.ResultsAllogeneic transfusion was required in 13 patients (36.1%) in the first group and four patients (11.4%) in the second group. The mean allogeneic transfusion volume was significantly low in the second group compared to the first group (64.4 mL vs. 278.9 mL; p<0.05). The hemoglobin level on the 1st postoperative day compared to the preoperative level decreased by 22.6% in the first group and 11.7% in the second group. The postoperative hemoglobin level was higher in the second group (p<0.05).ConclusionsMinimally invasive unilateral TKA with an autotransfusion system can be beneficial in patients with no medical complications because of the decreased allogeneic transfusion.

Efficacy of Intraoperative Cell Salvage Systems in Pediatric Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion With Segmental Spinal Instrumentation

Retrospective case-control study. Determine whether intraoperative cell salvage system use during pediatric posterior spinal fusion (PSF) with segmental spinal instrumentation for idiopathic scoliosis decreases intraoperative and perioperative (intraoperative plus postoperative) allogeneic blood transfusion. Intraoperative cell salvage and reinfusion can reduce or obviate perioperative allogeneic blood transfusion. Despite these benefits, their efficacy in pediatric PSF is unclear. Reported complications include transient hematuria, altered hemostasis, and electrolyte imbalance. A total of 54 consecutive idiopathic scoliosis patients were studied: 21 non-cell saver and 33 cell saver patients. Data included age, body mass index, Cobb angle, perioperative hemoglobin levels, mean arterial pressure, surgical time, levels fused, perioperative estimated blood loss, and perioperative transfusions. A chi2 and t tests were performed for intraoperative and perioperative allogeneic transfusion between groups. A regression analysis was performed between selected covariates and allogeneic transfusion. Relative risk analysis examined significant covariates regarding allogeneic transfusion rate. Allogeneic transfusion rates were lower in the cell saver group (6% vs. 55% intraoperative and 18% vs. 55% perioperative, P < 0.05). Mean allogeneic transfusion volumes (mL/kg) were also lower (0.4 vs. 9.1 intraoperative and 1.9 vs. 11.1 perioperative, P < 0.05). Multivariate analysis confirmed these differences were independent of perioperative blood loss, and also demonstrated that surgical time and blood loss were significantly related to allogeneic transfusion volume. The allogeneic transfusion relative risk was 2.04 in patients with surgery >6 hours and 5.87 in patients not receiving cell saver blood. All patients with surgeries >6 hours and estimated blood loss >30% of total blood volume received cell saver system blood. Cell saver use decreased allogeneic transfusion, particularly in surgeries >6 hours with estimated blood loss >30% of total blood volume. This study confirms the utility of routine cell saver use during PSF with segmental spinal instrumentation for idiopathic scoliosis.

Autologous Versus Allogeneic Transfusion in Aortic Surgery

To evaluate the efficacy of acute normovolemic hemodilution (ANH) and intraoperative cell salvage (ICS) in blood-conservation strategies for infrarenal aortic surgery. Recent concerns over the risks of transfusion-related infection have resulted in sharp rises in the cost of blood preparations. Autologous transfusion may be a safe alternative to allogeneic transfusion, which has been associated with immune modulation and postoperative infection. This multicenter prospective randomized trial compared standard transfusion practice with autologous transfusion combining ANH with ICS in 145 patients undergoing elective aortic surgery. The primary outcome measures were the proportion of patients requiring allogeneic blood and the volume of allogeneic transfusion. The secondary outcome measures were the frequency of complications, including postoperative infection, and postoperative hospital stay. The combination of ANH and ICS reduced the volume of allogeneic blood transfused from a median of two units to zero units. The proportion of patients transfused was 56% in allogeneic and 43% in autologous. There were no significant differences in complications or length of hospital stay. Both ANH and ICS were safe and reduced the allogeneic blood requirement in patients undergoing elective infrarenal aortic surgery.