Autotransfusion Group Research Articles

Impact of autotransfusion on recurrence of colorectal cancer liver metastasis: Long-term follow-up of patients undergoing curative intent hepatectomy.

Colorectal cancer liver metastasis (CRLM) occurs in upto 50% of cases and drives patient outcomes. Up-front liver resection is the treatment of choice in resectable cases. There is no consensus yet established as to the safety of intraoperative autotransfusion in liver resection for CRLM. Patients undergoing curative-intent hepatectomy for CRLM at a single quaternary-care institution from 1999 to 2016 were included. Demographics, surgical variables, Fong Clinical Risk Score (FCRS), use of intraoperative auto and/or allotransfusion, and survival data were analyzed. Propensity score matching (PSM) was performed accounting for allotransfusion, extent of hepatectomy, FCRS, and systemic treatment regimens. Three-hundred sixteen patients were included. The median follow-up was 10.4 years (7.8-14.1 years). The median recurrence-freesurvival (RFS) and overall survival (OS) in all patients were 1.6 years (interquartile range: 0.63-6.6 years) and 4.4 years (2.1-8.7), respectively. Before PSM, there was a significantly reduced RFS in the autotransfusion group (0.96 vs. 1.73 years, p = 0.20). There was no difference in OS (4.11 vs. 4.44 years, p = 0.118). Patients in groups of FCRS 0-2 and 3-5 both had reduced RFS when autotransfusion was used (p = 0.005). This reduction in RFS was further found when comparing autotransfusion versus no autotransfusion within the FCRS 0-2 group and within the FCRS 3-5 group (p = 0.027). On Cox-regression analysis, autotransfusion (hazard ratio = 1.423, 1.028-2.182, p = 0.015) remained predictive of RFS. After PSM, there were no differences in FCRS (p = 0.601), preoperative hemoglobin (p = 0.880), allotransfusion (p = 0.130), adjuvant chemotherapy (p = 1.000), immunotherapy (p = 0.172), tumor grade (p = 1.000), use of platinum-based chemotherapy (p = 0.548), or type of hepatic resection (p = 0.967). After matching, there was a higher rate of recurrence with autotransfusion (69.0% vs. 47.6%, p = 0.046). There was also a reduced time to recurrence in the autotransfusion group compared with the group without (p = 0.006). There was no difference in OS after PSM (p = 0.262). Autotransfusion may adversely affect recurrence in liver resection for CRLM. Until further studies clarify this risk profile, the use of intraoperative autotransfusion should be critically assessed on a case-by-case basis only when other resuscitation options are not available.

Effect and mechanism of immune surveillance activated by autotransfusion on reducing liver cancer metastasis based on HLA-DQB1/PDCD1

IntroductionLiver cancer is a common tumor of digestive system. Hepatectomy sometimes results in massive hemorrhage, and intraoperative autotransfusion is often required.Material and methodsMethods: In this basic research, the liver cancer rat model was established, and the visible liver cancer tissue was surgically removed, and the blood of the mice was recovered.ResultsThe results showed that the model group had the highest recurrence and metastasis of liver cancer, and the lowest was autotransfusion group. Flow cytometry showed that the number of HLA-DQB1 positive cells, the content of CD4+CD25+T cells, and the proliferation of CD4+T cells were the most in the autotransfusion group, followed by the model group, and the least in the auto+HLA-DQB1 group, which showed no difference from the control group. Immunohistochemistry and western blot analysis showed that the lowest expression of PDCD1 protein was in the autotransfusion group, which showed no significant difference from the control group, and the highest expression was in auto-HLA-DQB1, followed by the model group.ConclusionsIt elucidates the molecular mechanism that autotransfusion will activate the up-regulated expression of signal molecule HLA-DQB1, enhance the immune surveillance of CD4+T cells, reduce the expression of PDCD1 on the surface molecule of liver cancer cells, and inhibit liver cancer metastasis.Autotransfusion activated the expression of signaling molecule HLA-DQB1, enhanced the immune surveillance of CD4+T cells, reduced the expression of PDCD1 on the surface of liver cancer cells, and reduced the metastasis and recurrence of liver cancer.

Normovolumetric Haemodilution and Auto Transfusion in Major Operations Prevents Transfusion- Related Complications

Objective: To assess the efficacy and safety normovolumetric haemodilution and auto transfusion in patients undergoing major surgical operations. To compare the outcome differences between normovolumetric haemodilution and auto transfusion with allogenic transfusion group. Methods: The number and intensity of transfusion related complications in 36 patients, who received normovolumetric haemodilution and auto transfusion were compared with 36 patients who received similar amount of allogenic blood in the similar clinical environment and situation. The number and intensity of the complications encountered in study and control groups were compared and evaluated. Results: The study revealed statistically significant reduction in number and frequency of transfusion related complications in the study group comparing with the control group. The study also demonstrated reduction in number and intensity of surgery and anesthesia related complications compared with the control group without detection of harmful effect of haemodilution and auto transfusion. The study group also had statistically insignificant shorter hospital stay comparing with control group. Conclusion: Autologous transfusion with normovolemic haemodilution appears to be a safe and feasible method of reducing the need for homologous transfusion. Transfusion-related complications were significantly fewer in the autotransfusion group in comparison with allotransfusion, in patients undergoing major operations. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 547-552

The Effect of Pre-operative Autologous Blood Donation on Bone Marrow Hematopoietic Functions in Rabbits after Hepatectomy.

Pre-operative autologous blood donation (PABD) is one of the most widely distributed autologous blood donation means, which has positive effects on erythropoiesis. However, whether PABD can stimulate the bone marrow hematopoiesis after hepatectomy has not been reported. Totally 80 New Zealand rabbits were randomly divided into 4 groups that included control group, surgery group, hemodilutional autotransfusion (HA) group and PABD group. Automatic reticulocyte examination was performed to detect the content of reticulocyte and immature reticulocyte fractions (IRF). Flow cytometric analysis was employed to monitor the level of CD34+ cells and the cell cycle status. Southern blotting was conducted to determine the telomere length of CD34+ cells. The content of high fluorescence reticulocytes (HFR) and IRF was decreased at 6 h and 24 h after autotransfusion. However, the level of CD34+ cells was upregulated after PABD. Cell cycle status analysis revealed that the majority of the CD34+ cells in HA and PABD group were maintained in G0/G1 phase. The telomere length in HA and PABD group was shortened than that of the control group and surgery group. PABD could promote the bone marrow hematopoietic functions in rabbits after hepatectomy via stimulating proliferation of CD34+ cells and shortening the telomere length of CD34+ cells, but the content of HFR was not increased immediately because of the stuck of CD34+ cells in the G0/G1 phase.

Blood Salvage and Autotransfusion With Single Leukoreduction Does Not Increase the Risk of Tumor Recurrence After Liver Transplantation for Advanced Hepatocellular Carcinoma.

The aim of this study was to determine whether autotransfusion of salvaged blood with single leukoreduction is associated with post-transplant tumor recurrence in patients with advanced hepatocellular carcinoma (HCC). Previous studies have consistently demonstrated the safety of autotransfusion of salvaged and leukoreduced blood during liver transplantation for HCC. However, the effects of this technique remained unknown for advanced HCC. Of 349 patients who underwent living donor liver transplantation for advanced HCC: 74 of 129 without autotransfusion were matched with 74 of 220 with autotransfusion using propensity score based on tumor biology, allogeneic transfusion, and others. Survival analysis was performed with death as a competing risk event. The primary outcome was HCC recurrence. Recipients in autotransfusion group received 811 (497-1247) mL of salvaged blood with single leukoreduction. In the matched cohort, cumulative overall recurrence probability at 1/2/5 years after transplantation was 24.6%/ 38.3%/39.7% for nonautotransfusion group and 16.2%/23.1%/32.5% for autotransfusion group. There were no significant differences between the 2 groups in overall recurrence [hazard ratio (HR) = 0.72 (0.43-1.21)], intrahepatic recurrence [HR = 0.70 (0.35-1.40)], and extrahepatic recurrence [HR = 0.82 (0.46-1.47)]. Also, there were no significant differences in overall death [HR = 0.57 (0.29-1.12)], HCC-related death [HR = 0.59 (0.29-1.20)], and HCC-unrelated death [HR = 0.48 (0.09-2.65)]. When allogeneic transfusion was matched, autotransfusion was not significantly related to HCC recurrence, with more favorable probabilities for autotransfusion, in patients with advanced HCC. Thus, blood salvage and autotransfusion could be safely used with single leukoreduction, without double-filtered leukoreduction, during liver transplantation for HCC with potential benefits from avoiding allogeneic red blood cell transfusion.

Clinical effects among different strategies of autologous blood transfusion

Objective To investigate effectiveness of different strategies of autologous blood transfusion, in order to promote development of autologous blood transfusion in medical institutions, and to ensure the safety of clinical transfusion. Methods From January 2014 to July 2016, a total of 88 patients undergoing orthopedic surgery who received autologous blood transfusion in General Hospital of Beijing Military Region or Dalian Municipal Central Hospital, were randomly selected as research objects by simple random sampling method. A simple random grouping method was used to classify the patients into intraoperative salvaged autotransfusion group (n=43), stored autologous whole blood transfusion group (n=25), and stored autologous red blood cells transfusion group (n=20). A total of 42 patients undergoing orthopaedic surgery who received allogeneic blood transfusion were randomly selected from above hospital during the same period by simple random sampling method, and they were included in control group (n=42). The data including patients′ red blood cell count, hemoglobin (Hb) level, hematocrit (HCT) and platelet count were collected and analyzed in different time points which were before blood collection/surgery, the first day after blood transfusion, the fourth day after blood transfusion. And days of hospitalization, volume of bleeding in the operation, infusion volume of allogeneic blood in each group were also collected and analyzed. Statistical methods were used to compare the differences of the above indexes among 4 groups. Results ① There were no statistically significant differences in red blood cell count, Hb level, HCT, platelet count among patients of 4 groups before blood collection/surgery (P>0.05). ② There were no statistically significant difference in red blood cell count, Hb level, HCT among patients of 4 groups on the first day after blood transfusion. But there was significant differences in platelet count among 4 groups (F=4.157, P=0.008). And platelet count of patients in stored autologous whole blood transfusion group was the highest, as (196.0±43.80)×109/L. Among them, compared with control and intraoperative salvaged autotransfusion groups respectively, the differences were statistically significant (P=0.004, 0.009). However, compared with stored autologous red blood cells transfusion group, the difference was not statistically significant (P=0.653). ③ There was no statistically significant difference in red blood cell count of patients in 4 groups on the fourth days after blood transfusion (P>0.05). Comparison of Hb level in 4 groups, the difference was statistically significant (F=3.764, P=0.013). Hb level of patients in intraoperative salvaged autotransfusion group was the highest [(115.6±23.8) g/L], which compared with stored autologous transfusion and control groups respectively, the differences were statistically significant (P=0.006, 0.022), but there was no statistically significant that compared with preoperative autologous red blood cells group (P=0.878). Comparison of HCT in these 4 groups, the difference was statistically significant (F=3.915, P=0.011). The HCT of patients in the stored autologous red blood cells transfusion group was the highest [(34.4±4.8)%] among 4 groups, which compared with control group, the difference was statistically significant (P=0.012); but compared with stored autologous whole blood transfusion and intraoperative salvaged autotransfusion groups respectively, the differences were not statistically significant (P=0.059, 0.819). ④ There were no statistically differences observed in bleeding volume and allogeneic blood transfusion volume in the operation among 4 groups (P>0.05). Hospitalization days were compared, and the difference was statistically significant (χ2=11.990, P=0.007). Among them, patients in control group had the highest hospitalization days [14.5 d(9.5-16.0 d)], which compared with stored autologous whole blood transfusion group, the difference was statistically significant (P=0.007); compared with stored autologous red blood cells transfusion and intraoperative salvaged autotransfusion group respectively, the differences were not statistically significant (P=0.09, 0.944). Conclusions For the selection of auto logous blood infusion strategies in patients undergoing elective surgery in clinical, preferred to use stored autologous red blood cells transfusion, followed by stored autologous whole blood transfusion and intraoperative salvaged autotransfusion. When autologous blood transfusion is not available, allogeneic blood transfusion could be used. Therefore, clinicians need to change their ideas to reduce the rate of allogeneic blood transfusion gradually, and to develop the autologous blood transfusion extensively and effectively, so as to ensure the safety of clinical blood transfusion. Key words: Blood transfusion, autologous; Blood component transfusion; Apheresis red blood cells; Allogeneic transfusion

Safety of the Use of Blood Salvage and Autotransfusion During Liver Transplantation for Hepatocellular Carcinoma

To determine whether autotransfusion of red blood cells (RBCs) salvaged during liver transplantation is associated with the recurrence of hepatocellular carcinoma (HCC). Blood salvage is widely used during liver transplantation to reinfuse salvaged autologous RBCs and reduce allogeneic transfusion. However, the reintroduction of cancer cells via autotransfusion is a major concern in HCC patients. Among 397 patients who underwent living-donor liver transplantation for HCC, 97 of 114 recipients without intraoperative autotransfusion were matched with 222 of 283 recipients with intraoperative autotransfusion with unfixed matching ratio using the propensity score based on age, sex, allogeneic transfusion, immunosuppression, tumor biology, and others. Competing risks Cox regression was used to compare HCC recurrence risk of the 2 paired groups. Recipients in autotransfusion group received 1177 ± 1318 mL of salvaged RBCs during surgery. A leukocyte depletion filter was used for all autotransfused RBCs. Cumulative HCC recurrence rate at 1, 2, and 5 years after transplantation were 10.4% (5.3%-17.6%), 19.1% (11.6%-28.0%), and 24.1% (15.2%-34.0%) for nonautotransfusion group and 10.8% (7.2%-15.4%), 14.9% (10.5%-20.0%), and 20.3% (14.9%-26.4%) for autotransfusion group, respectively. Autotransfusion versus nonautotransfusion group was not significantly different in overall recurrence [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.47-1.53, P = 0.579] and intrahepatic recurrence (HR 0.75, 95% CI 0.36-1.56) or extrahepatic recurrence (HR 1.00, 95% CI 0.49-2.04). We found no evidence of a significant impact of autotransfusion on posttransplant HCC recurrence. Thus, salvaged and filtered RBCs could be used in HCC patients undergoing liver transplantation with potential benefits from avoiding allogeneic RBCs transfusion and its complications.

Comparison of effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in patients undergoing cesarean section

Objective To compare the effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in the patients undergoing cesarean section. Methods Sixty patients, aged 20-35 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective cesarean section, were randomly divided into 2 groups(n = 30 each)using a random number table: hemodiluted autotransfusion group(group HAT)and allogeneic blood transfusion group(group ABT). Both groups received epidural anesthesia.The radial artery was cannulated after epidural anesthesia, and the autologous blood was collected in group HAT.The autologous blood transfusion timing: intraoperative blood loss was expected to exceed 20% of blood volume.For the patients in whom intraoperative blood loss was not expected to exceed 20% of blood volume, bleeding was stopped, and autologous blood was infused intravenously after peritoneum closure.The allogeneic blood transfusion timing: when hemoglobin 1.5 times of the normal value, the fresh frozen plasma 100-400 ml was infused intravenously; when platelet count<50×109/L, platelets 10-40 U were infused intravenously.When entering the operating room(T0), on 1st day after operation(T1), and on 5th day after operation(T2), blood samples were collected to detect the levels of T lymphocyte subsets CD3+ , CD4+ and CD8+ (using FACScan flow cytometer), and serum interleukin-2(IL-2)and IL-6 concentrations(by enzyme-linked immunosorbent assay). CD4+ /CD8+ ratio was calculated. Results Compared with the values at T0, the levels of CD3+ and CD4+ , CD4+ /CD8+ ratio, and serum IL-2 concentrations were significantly decreased, and the serum IL-6 concentrations were increased at T1, 2 in group ABT, and at T1 in group HAT(P<0.05). Compared with group ABT, the CD3+ and CD4+ levels, CD4+ /CD8+ ratio and serum IL-6 concentrations were significantly increased at T1, and the serum IL-2 concentrations were increased at T1, 2 in group HAT(P<0.05). Conclusion Compared with allogeneic transfusion, hemodiluted autotransfusion has less inhibitory effect on cellular immune function in the patients undergoing cesarean section. Key words: Blood transfusion, autologous; Blood component transfusion; Cesarean section; Immunity, cellular

Autotransfusion in emergent operative trauma resuscitation.

Autotransfusion of red cells is common in many surgical specialties. However, this technique is not uniformly used in abdominal trauma. The purpose of this paper is to study the outcomes of patients who were autotransfused during emergency trauma operations in which they sustained full-thickness hollow viscus injury (HVI). A total of 179 patients in period 1999-2008 with penetrating and blunt abdominal trauma requiring intraoperative blood transfusion were evaluated. Recipients of autotransfusion and banked blood (autotransfused group) were compared with recipients of banked blood products only (control group). The t-test, Chi-squared, and Fisher's exact test were used to evaluate the data. Multivariate regression analysis evaluated the primary outcomes, survival and bloodstream infection (BSI). Of the 179 patients, 108 controls and 71 autotransfused patients were evaluated. The results showed no statistically significant difference between the control and autotransfusion groups regarding age, injury pattern/severity [Injury Severity Score (ISS)], length of stay, postoperative international normalized ratio (INR), and volume of banked blood products. Both groups were also proportional with colon injury. The estimated operative blood loss (EBL) was 2,472±3,261 for controls and 4,056±3,825 for the autotransfused group (p=0.0001). The total volume of blood transfused was 2,792 and 5,513 for controls and patients in the autotransfusion group, respectively (p=0.002). Ninety controls (84%) and 53 autotransfused patients (76%) survived to discharge (p=0.21). Twenty controls (49%) and 17 autotransfused patients (45%) developed BSI (p=0.72). Logistic regression analysis revealed that an ISS>25, systolic blood pressure <90, and EBL>2L predicted mortality. There was also a trend towards decreased survival with age>50 years. We found no evidence that emergent autotransfusion worsens clinical outcomes in the setting of concomitant HVI.

Impact of Allogenic and Autologous Transfusion on Immune Function in Patients with Tumors

To observe the effects of allogeneic and autologous transfusion on cellular immunity, humoral immunity and secretion of serum inflammatory factors and perforin during the perioperative period in patients with malignant tumors. A total of 80 patients (age: 38-69 years; body weight: 40-78 kg; ASA I - II) receiving radical operation for gastro-intestinal cancer under general anesthesia were selected. All the patients were divided into four groups based on the methods of infusion and blood transfusion: blank control group (Group C), allogeneic transfusion group (group A), hemodiluted autotransfusion Group (Group H) and hemodiluted autotransfusion + allogenic transfusion Group (A+H group). Venous blood was collected when entering into the surgery room (T0), immediately after surgery (T1) and 24h (T2), 3d (T3) and 7d (T4) after surgery, respectively. Moreover, flow cytometry was applied to assess changes of peripheral blood T cell subpopulations and NK cells. Enzyme linked immunosorbent assays were performed to determine levels of IL-2, IL-10, TNF-α and perforin. Immune turbidimetry was employed to determine the changes in serum immunoglobulin. Both CD3+ and NK cells showed a decrease at T1 and T2 in each group, among which, in group A, CD3+ decreased significantly at T2 (P<0.05) compared with other groups, and CD3+ and NK cell reduced obviously only in group A at T3 and T4 (P<0.05). CD4+ cells and the ratio of D4+/CD8+ were decreased in groups A, C and A+H at T1 and T2 (P<0.05). No significant intra- and inter-group differences were observed in CD8+ of the four groups (P<0.05). IL-2 declined in group C at T1 and T2 (P<0.05) and showed a decrease in group A at each time point (P<0.05). Moreover, IL-2 decreased in group A + H only at T1. No significant difference was found in each group at T1 (P<0.05). More significant decrease in group C at T2, T3 and T4 compared with group A (P<0.05), and there were no significant differences among other groups (P>0.05). IL-10 increased at T1 and T2 in each group (P<0.05), in which it had an obvious increase in group A, and increase of IL-10 occurred only in group A at T3 and T4 (P<0.05). TNF-α level rose at T1 (P<0.05), no inter- and intra-group difference was found in perforin in all groups (P<0.05). Compared with the preoperation, both IgG and IgA level decreased at T1 in each group (P<0.05), and they declined only in Group A at T2 and T3 (P<0.05), and these parameters were back to the preoperative levels in other groups. No significant differences were observed between preoperative and postoperative IgG and IgA levels in each group at T4 (P>0.05). No obvious inter- and intra-group changes were found in IgM in the four groups (P>0.05). Allogeneic transfusion during the perioperative period could obviously decrease the number of T cell subpopulations and NK cells and the secretion of stimulating cytokines and increase the secretion of inhibiting cytokines in patients with malignant tumors, thus causing a Th1/Th2 imbalance and transient decreasing in the content of plasma immune globulin. Autologous transfusion has little impact and may even bring about some improvement of postoperative immune function in patients with tumors. Therefore, cancer patients should receive active autologous transfusion during the perioperative period in place of allogeneic transfusion.

Delayed drainage versus autotransfusion drainage and routine drainage after total knee arthroplasty: a comparative study

BackgroundThe purpose of this research is to compare the clinical results of different drainage methods in total knee arthroplasty (TKA).MethodsThis retrospective comparative study included 55 patients who accepted primary unilateral TKA between October 2010 and November 2012. The patients were classified according to the drainage method used: 25 patients in the autotransfusion drainage group, 12 patients in the delayed drainage group, and 18 patients in the routine drainage group. Otherwise, the same operative procedures and postoperative care were applied to all patients. The variables recorded included total amount of postoperative drainage (including intraoperative blood loss); cases of allogenic blood transfusion; body temperatures on postoperative days 1, 3, and 7; and pre- and postoperative hemoglobin level. Some other elements such as postoperative swelling, range of motion, and wound healing were also compared.ResultsPatients who underwent autotransfusion were found to have an amount of drainage (799.2 ± 196.7 mL) significantly greater than that in the routine drainage group (666.1 ± 155.0 mL), which in turn was significantly greater than that in the delayed drainage group (381.7 ± 129.2 mL). The postoperative hemoglobin level in the delayed drainage group (91.5 ± 7.9 g/L) was similar to that in the autotransfusion group (92.0 ± 9.6 g/L), while that in the routine drainage group (81.3 ± 9.9 g/L) was significantly lower. The patients in the autotransfusion group were observed to have higher body temperatures than those in the other two groups. In the routine drainage group, eight cases accepted allogenic blood transfusion, and the percentage (44.4%) was significantly higher than that in the other two groups. There were no significant between-group differences in swelling, healing qualities, and range of motion.ConclusionsDelayed postoperative drainage may reduce blood loss and the chance of allogenic blood transfusion compared with routine drainage and may also reduce the chance of postoperative fever and extra costs compared with autotransfusion.

Low vacuum re-infusion drains after total knee arthroplasty: is there a real benefit?

Low vacuum re-infusion drains after total knee arthroplasty: is there a real benefit?

Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty: a randomised controlled trial.

A new intraoperative filtered salvaged blood re-transfusion system has been developed for primary total hip arthroplasty (THA) that filters and re-transfuses the blood that is lost during THA. This system is intended to increase postoperative haemoglobin (Hb) levels, reduce perioperative net blood loss and reduce the need for allogeneic transfusions. It supposedly does not have the disadvantages of intraoperative cell-washing/separating re-transfusion systems, such as extensive procedure, high costs and need for specialised personnel. To re-transfuse as much as blood as possible, postoperatively drained blood was also re-transfused. A randomised, controlled, blinded, single-centre trial was conducted in which 118 THA patients were randomised to an intraoperative autologous blood re-transfusion (ABT) filter system combined with a postoperative ABT filter unit or high-vacuum closed-suction drainage. On average, 577 ml of blood was re-transfused in the ABT group: 323 ml collected intraoperatively and 254 ml collected postoperatively. Hb level was higher in the ABT vs the high-vacuum drainage group: 11.4 vs. 10.8 g/dl, p = 0.02 on day one (primary endpoint) and 11.0 vs. 10.4 g/dl, p = 0.007 on day three. Total blood loss was less in the autotransfusion group: 1472 vs. 1678 ml, p = 0.03. Allogeneic transfusions were needed in 3.6 % of patients in the ABT group and 6.5 % in the drainage group, p = 0.68. The use of a new intraoperative ABT filter system combined with a postoperative ABT unit resulted in higher postoperative Hb levels and less total blood loss compared with a high-vacuum drain following THA.

A comparative study on different postoperative drainage ways in total knee arthroplasty

Objective To compare the clinical outcomes of different drains in total knee arthroplasty.Methods Fifty-five patients,who had accepted primary unilateral total knee arthroplasty from October 2010 to November 2012,were included in the comparative study.Based on different drainage ways,25 patients were arranged into autotransfusion drain group,18 into routine drain group,and 12 into delayed drain group.Same operative procedure and postoperative care were provided to all patients.The total amount of postoperative drainage (including intraoperative blood loss),information of allogenic blood transfusion,body temperatures of patients on postoperative 1st,3rd,7th day,pre-and post-operative hemoglobin level,and postoperative swelling,wound healing quality and range of motion were recorded and compared.Results The amount of drainage was significantly more in autotransfusion drain group (799.2±196.7ml)than those in other two groups (381.7±129.2 ml in delayed drain group and 666.1±155.0ml in routine drain group).The postoperative hemoglobin level in delayed drain group (91.50±7.92 g/L)was similar to that in autotransfusion group (91.96±9.57 g/L),while significantly higher than that in routine drain group (81.33±9.86 g/L).The highest body temperature of patients in autotransfusion drain group was higher than those in other two groups.Allogenic blood transfusion was performed in 8 patients (44.4％) in routine drain group,4 patients (16.0％) in autotransfusion drain group and 2 patients (16.7％) in delayed drain group.There were no differences between groups in swelling,wound healing quality,and range of motion.Conclusion Delayed release of drain in total knee arthroplasty could reduce blood loss,chances of allogenic blood transfusion and postoperative fever,and extra cost,which can bring more benefits to patients. Key words: Arthroplasty, replacement, knee; Drainage; Comparative study

Reduction of blood loss with the use of a new combined intra-operative and post-operative autologous blood transfusion system compared with no drainage in primary total hip replacement

Autologous retransfusion and no-drainage are both blood-saving measures in total hip replacement (THR). A new combined intra- and post-operative autotransfusion filter system has been developed especially for primary THR, and we conducted a randomised controlled blinded study comparing this with no-drainage. A total of 204 THR patients were randomised to autologous blood transfusion (ABT) (n = 102) or no-drainage (n = 102). In the ABT group, a mean of 488 ml (sd 252) of blood was retransfused. The mean lowest post-operative haemoglobin level during the hospital stay was higher in the autotransfusion group (10.6 g/dl (7.8 to 13.9) vs 10.2 g/dl (7.5 to 13.3); p = 0.01). The mean haemoglobin levels for the ABT and no-drainage groups were not significantly different on the first day (11.3 g/dl (7.8 to 13.9) vs 11.0 g/dl (8.1 to 13.4); p = 0.07), the second day (11.1 g/dl (8.2 to 13.8) vs 10.8 g/dl (7.5 to 13.3); p = 0.09) or the third day (10.8 g/dl (8.0 to 13.0) vs 10.6 g/dl (7.5 to 14.1); p = 0.15). The mean total peri-operative net blood loss was 1464 ml (sd 505) in the ABT group and 1654 ml (sd 553) in the no-drainage group (p = 0.01). Homologous blood transfusions were needed in four patients (3.9%) in the ABT group and nine (8.8%) in the no-drainage group (p = 0.15). No statistically significant difference in adverse events was found between the groups. The use of a new intra- and post-operative autologous blood transfusion filter system results in less total blood loss and a smaller maximum decrease in haemoglobin levels than no-drainage following primary THR.

Postoperative autotransfusion of mediastinal shed blood does not influence haemostasis after elective coronary artery bypass grafting☆

The rationale of using autotransfusion of mediastinal shed blood after cardiac surgery is to preserve haemoglobin levels and reduce the need for allogenic blood transfusions. However, the method is controversial and its clinical value has been questioned. We hypothesised that re-transfusion of mediastinal shed blood instead impairs haemostasis after routine coronary artery bypass grafting and thus increases postoperative bleeding. Seventy-seven consecutive elective coronary artery bypass surgery patients (mean age 67±9 years, 77% men) were included in a prospective, randomised controlled study. The patients were randomised to postoperative re-transfusion of mediastinal shed blood (n=39) or to a group where mediastinal shed blood was discarded (n=38). Primary end point was bleeding during the first 12 postoperative hours. Secondary end points were postoperative transfusion requirements, haemoglobin levels, thrombo-elastometric variables and plasma concentrations of interleukin-6, thrombin-anti-thrombin complex and D-dimer. Mean re-transfused volume in the autotransfusion group was 282±210 ml. There was no difference in postoperative bleeding (median 394 ml (interquartile range 270-480) vs 385 (255-430) ml, p=0.69), proportion of patients receiving transfusions of blood products (11/39 vs 11/38, p=0.95), haemoglobin levels 24h after surgery (116±13 vs 116±14 g l(-1), p=0.87), thrombo-elastometric variables, interleukin-6 (219±144 vs 201±144 pg ml(-1), p=0.59), thrombin-anti-thrombin complex (11.0±9.1 vs 14.8±15, p=0.19) or D-dimer (0.56±0.49 vs 0.54±0.44, p=0.79) between the autotransfusion group and the no-autotransfusion group. Autotransfusion of small-to-moderate amounts of mediastinal shed blood does not influence haemostasis after elective coronary artery bypass grafting.

Effects of Tranexamic Acid and Autotransfusion in Coronary Artery Bypass

The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on postoperative bleeding and the need for allogeneic transfusion. In a prospective randomized study, 200 patients undergoing coronary artery bypass were divided into two groups: 100 patients received 1-2 units of autologous blood after termination of cardiopulmonary bypass; and 100 patients were given tranexamic acid 15 mg x kg(-1) before injection of heparin and again before injection of protamine. Postoperative bleeding was significantly lower in the tranexamic acid group (600 mL) than the autotransfusion group (1,100 mL). The percentage of patients transfused in the autotransfusion and tranexamic acid groups was 70% and 65%, respectively. Patients in the autotransfusion group received significantly more whole blood (2.82 vs 1.93 units). Intensive care and hospital stays were shorter in the tranexamic acid group. There was no hospital mortality and no difference in thrombotic complications between groups. Tranexamic acid was more effective than autotransfusion in reducing postoperative blood loss and allogeneic transfusions after coronary bypass.

Effect of shed blood retransfusion on pulmonary perfusion after total knee arthroplasty: a prospective controlled study

Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method following major surgical operations, such as total knee arthroplasty (TKA). The systemic effects of shed blood are still unclear. We studied the effect of residual substances in the retransfused shed blood, on lung perfusion after TKA. Fifteen unilateral and one bilateral TKAs were performed with autotransfusion (the study group) and 15 unilateral and three bilateral TKAs were performed in a control group. Lung X-rays, arterial blood gases (ABG), D-dimer values, and lung perfusion scintigraphies were performed preoperatively and postoperatively. A mean of 300.0 +/- 335.6 ml of bank blood was needed in the autotransfusion group and a mean of 685.7 +/- 365.5 ml of bank blood was needed in the control group (p=0.001). There was a postoperative segmental perfusion defect at the lateral segment of the superior lobe of the left lung in one patient of the control group and he also had risk factors for thrombosis. Although both groups had a decrease in lung perfusion postoperatively, there were no significant differences among the groups regarding the lung perfusion scintigraphy, chest X-rays, ABG, and D-dimer values. In conclusion, although pulmonary perfusion diminishes following TKA, shed blood retransfusion does not add any risk to pulmonary perfusion.

Effect of Autotransfusion Using the Drained Blood after Bilaterla Total Knee Arthroplasty

Background: This study investigated the clinical usefulness of an autotransfusion of drained blood using postoperative wound drainage and a reinfusion system to reduce the allogenic blood transfusion without complications. Methods: Eighty patients were allocated randomly to either a control group using a standard drainage system or an autotransfusion group using postoperative wound drainage and a reinfusion system. The collection period was 12 h, and the drainage blood retransfused after 6 h, or a maximum of 500 ml of blood was collected after connecting the reinfusion system. Immediately before reinfusion, blood samples were taken from the reinfusion system and analyzed for the functional and metabolic status of the drained blood and compared with the preoperative values of patient. The hemoglobin level, blood loss, allogenic blood requirement and transfusion-related complications were assessed. Results: The drained blood had lower hematological values, a prolonged PT and aPTT, a lower fibrinogen, and metabolic acidotic status than the preoperative values of the patients. There were no significant differences in the amount of blood loss compared with the control group. However, the autotransfusion group required significantly less allogenic blood (almost 20% less) without significant complications. Conclusions: Autotransfusion by reinfusion with drained blood in bilateral total knee arthroplasty reduces the allogenic blood requirement without significant complications.

Effects of autotransfusion of mediastinal shed blood on biochemical markers of myocardial damage in coronary surgery

Previous studies have shown conflicting results regarding the effect of autotransfusion of mediastinal shed blood after coronary artery bypass grafting (CABG) on the serum levels of myocardial band (MB) isoenzymes of creatine kinase (CK-MB) and cardiac troponins. The effect of autotransfusion on serum levels of human heart fatty acid binding protein (H-FABP), another marker of myocardial necrosis, has not been studied. The aim of the present study was to investigate the effects of autotransfusion of mediastinal shed blood on the serum levels of CK-MB, cardiac troponin T (cTnT), and H-FABP after uncomplicated primary CABG. Fifty patients were randomized to post-operative autotransfusion of mediastinal shed blood or no autotransfusion. Blood samples for the analysis of the biochemical markers of myocardial damage were drawn pre-operatively and 1, 4, 12, 24, 48, and 72 h after the termination of cardiopulmonary bypass. Samples from the mediastinal shed blood were collected after 1 and 4 h. The levels of the biochemical markers of myocardial injury were all markedly elevated in mediastinal shed blood. Autotransfusion did not significantly affect the serum levels of cTnT or H-FABP. However, during the early post-operative hours, there was a trend towards a higher level of cTnT and H-FABP in the autotransfusion group. During the first 24 h after surgery, the autotransfusion group had a significantly higher serum level of CK-MB. Post-operative autotransfusion of mediastinal shed blood may contribute to elevated serum levels of biochemical markers of myocardial injury.