Autotransfusion Of Blood Research Articles

Intraoperative Autotransfusion in Aortic Surgery

Abstract Purpose: Intraoperative autotransfusion is frequently used in aortic surgery, despite the paucity of data regarding its safety and efficacy. This study was designed to compare whole blood autotransfusion with homologous transfusion for the replacement of blood lost during abdominal aortic procedures. Methods: Whole blood autotransfusion was evaluated in 200 patients undergoing aortic reconstructive procedures during a 3-year period. Collection and reinfusion of unwashed filtered shed blood was undertaken in 100 patients, and clinical, laboratory, and economic parameters were compared with those in a group of 100 patients undergoing aortic operation with homologous banked blood replacement. Results: The two groups were comparable with respect to demography, the type of procedure, baseline laboratory profile, and the frequency of coexistent medical illnesses. The amount of blood salvaged and reinfused averaged 1729 ± 68 ml in the autotransfusion group. Patients undergoing autotransfusion received a mean of 0.6 ± 0.1 units of banked blood during operation, compared with 3.4 ± 0.1 units in the homologous group ( p 3 /mm 3 , p p p p p Conclusion: These data suggest that autotransfusion of unwashed, filtered blood is a safe and efficacious alternative to homologous blood replacement in patients undergoing major aortic reconstructive procedures. (J VASC SURG 1993;18:16-22.)

Shed blood autotransfusion influences ischemia-sensitive laboratory parameters after coronary operations

The diagnostic significance of ischemia-sensitive laboratory parameters in respect to possible interference with shed blood antotransfusion was assessed in a prospective study with 100 patients undergoing elective coronary artery bypass grafting. Serum levels of creatine kinase, crsatine Kinase MB activity, creatine kinase MB mass concenteation, 2-hydroxybulyrale dehydrogenase, lactate dehydnogenase-1, troponin-T, myoglobin, and glutamicoxaloacetic transaminase werw repeatedly assessed up to the sixth postoperative day. Thirty-seven patients were excluded from the study due to postoperative development of myocardial infarction (n = 4), transient ischemic eventa (n = 25), and left bundle-branch blocks (n = 8). In the ramaining group of 63, 37 patients were retransfused with 580 ± 370 mL shed blood up to the twelfth postoperative hour, and 26 patients did not receive autotransfusion due to minimal mediastinal blood loss, the results of our study show that the ischemia-sensitive laboratory parameters were significantly influenced by shed blood autotransfusion: 8 hours postoperatively, creatine kinase (272%), creatine kinase MB fraction (151%) 2-hydroxybutyrate dehydrogenase (130%), lactate dehydiogenase-1 (133%), troponin-T (200%), myoglobin (159%) and glutamic-oxaloacetic transaminase Ievels (153%) were significantly elevated ( p < 0.05) in patients with posloperative autotransfusion, although there were no electrocardiographic signs of myocardial ischemia in this group of patients. Our study shows that postoperative autotransfusion of mediastinal shed blood may interfere with the diagnosis of perioperative myocardial ischemia by laboratory parameters in corunary bypass patients.

Blood Conservation and Autotransfusion in Cardiac Surgery

Blood Conservation and Autotransfusion in Cardiac Surgery

Intraoperative predonation contributes to blood saving

The merits of reinfusing prebypass-removed autologous blood (intraoperative predonation) to salvage blood and improve postoperative hemostasis are still debated, specifically for patients at a higher risk for bleeding. To evaluate the effect of intraoperative predonation on the platelet count, blood hemoglobin content, and blood saving postoperatively, we retrospectively studied 100 matching patients. All patients underwent internal mammary artery bypass surgery resulting in a considerable blood loss postoperatively. Intraoperative predonation (800 ml), reinfusion of the residual volume of the extracorporeal circuit, autotransfusion of shed blood, and acceptance of normovolemic anemia postoperatively was the approach adopted in 50 patients (group 1). A similar blood salvage program, excluding intraoperative predonation, was carried out in the other 50 patients (group 2), and these served as the control group. The platelet counts and blood hemoglobin content were significantly higher postoperatively ( p < 0.01) in the predonated patients than in the control patients. However, the net blood loss, the amount of retransfused shed blood, and the blood requirements postoperatively were significantly less ( p < 0.01) in the predonated patients than in the control patients, whereas 65% of the predonated patients versus 10% of the control patients did not need any donor blood products. In conclusion, predonation reduces the postoperative blood loss and thereby importantly ameliorates the blood-saving effect of a blood salvage program after IMA procedures.

Cell washing versus immediate reinfusion of intraoperatively shed blood during abdominal aortic aneurysm repair

Significant hematologic changes are known to occur following intraoperative autotransfusion of shed blood, but the clinical importance of cell washing prior to reinfusion has not been substantiated. To evaluate these changes and their relationship to the use of blood bank products and postoperative morbidity, 26 patients undergoing elective abdominal aortic aneurysm repair were prospectively randomized to reinfusion with washed shed blood or to the use of a collection system in which filtered, but unwashed, whole blood was reinfused intraoperatively. Each patient was evaluated with respect to standard metabolic and hematologic laboratory parameters preoperatively, immediately postoperatively, and 12 to 18 hours postoperatively. Patient demographic data were similar for both groups. Perioperative survival was 100% for both groups. Total blood loss and blood volume autotransfused were significantly greater in the unwashed cell group compared with the washed cell group (p = 0.00014 and p = 0.00011, respectively). Hemoglobin, fibrinogen, prothrombin time, and partial thromboplastin time levels were not significantly different between the two groups at any time perioperatively; fibrin split product and d-dimer levels were significantly higher in the unwashed cell group postoperatively (p = 0.016 and p < 0.001, respectively). Serum free hemoglobin levels were significantly higher in the immediate postoperative period in the unwashed cell group compared with the washed cell group (p = 0.0013); by 12 to 18 hours postoperatively, this difference was not significant. Haptoglobin levels were significantly lower in the unwashed cell group at both postoperative times (123 +/- 86 mg/dL versus 41 +/- 50 mg/dL, p = 0.0086; 102 +/- 66 mg/dL versus 24 +/- 36 mg/dL, p = 0.0001); however, there was no perioperative renal failure in either group. Furthermore, homologous blood product use was not significantly different between the two groups, with an average of 1.5 +/- 2.5 units of packed red blood cells given to patients in the unwashed cell group versus 0.8 +/- 1.7 units in the washed cell group (p = 0.419). Overall complications were higher and critical care and total hospital stays were longer in the unwashed cell group but did not result from autotransfusion of unwashed blood. We conclude that the intraoperative reinfusion of unwashed shed blood is safe and effective, causing transient hematologic abnormalities that normalize in the early postoperative period, and is not associated with increased mortality, or hematologic, cardiopulmonary, or renal complications.

Autotransfusion Program: Integrated Use of Different Techniques

A successful autologous program should enroll all appropriate patients, conserve homologous blood and minimise the exposure to the risks of donor blood. A program of autotransfusion and proper use of blood has been implemented since 1980 with the objectives to include all eligible patients and to transfuse autologous blood only. The following strategies were adopted: critical review of transfusion indications; control of overtransfusion; avoidance of waste; systematic and integrated use of all autotransfusion techniques currently available. Results in 1992 in elective surgery: 98% enrollment, 75% blood conservation. Exposure to homologous blood was completely avoided in 53% of the cases.

Autotransfusion of shed blood contributes additionally to blood saving in patients receiving aprotinin (2 million KIU)

Aprotinin decreases the hemoglobin content of shed blood significantly and thereby could potentially reduce the contribution of autotransfusion of shed blood to the blood-saving program. In part 1, by means of a prospective randomized study, we evaluated the effect of autotransfusion (AT) of shed blood on the reduction and avoidance of donor blood requirements in 40 matched patients undergoing internal mammary artery bypass (IMA) surgery and treatment with low-dose aprotinin (2 million KIU). Twenty patients (Group 1) received AT with a hard shell cardiotomy reservoir; twenty patients (Group 2, control) did not receive AT. In part 2, we studied at random the hemoglobin and total-protein content of shed blood in 10 patients of group 2 and in 10 IMA patients not receiving aprotinin. Retransfused patients required 0.1 +/- 0.3 units of donor blood versus 0.8 +/- 0.2 units in non-retransfused patients (not significant). The use of any blood product was avoided in 95% and 80% of the patients, respectively (not significant). Patients receiving aprotinin lost 50% less (P < 0.05) hemoglobin (62 g) and total-protein (28 g) in their drainage system than patients not receiving aprotinin. It was calculated that autotransfusion of about 530 ml of shed blood in aprotinin-treated patients, is equivalent to 0.4 units of homologous packed cells. In conclusion, autotransfusion of shed blood may contribute to blood saving in IMA patients treated with aprotinin, which reduces the shed blood hemoglobin and total protein content by 50%.

Red blood cell salvage during hip replacement and abdominal aortic surgery. (Short communication).

Autotransfusion of shed blood during surgery has now been used for more than a decade. In the recent years the development of safe and fast operating equipment for red blood cell salvage (1, 3) has led to a widespread use of autotranfusion.

Use of predeposit autologous blood and intraoperative autotransfusion in urologic cancer surgery

A total of 20 patients underwent major urologic cancer surgery with the combined use of predeposit autologous blood and intraoperative autotransfusion with the Haemonetics Cell Saver. The estimated blood loss ranged from 400 to 2,000 mL (mean 1,208 mL). Total transfusion requirements for the 20 patients were 85.5 units of which 82.5 (96 %) were autologous. Predeposit autologous blood accounted for 53 percent, intraoperative autotransfusion blood 43 percent, and homologous blood 4 percent of the total transfusion requirements Of the 20 patients in the study, only 1 received homologous blood. There were no complications related to either modality of autotransfusion. Our data suggest that using the combined modalities of predeposit autologous blood donation and intraoperative autotransfusion, major urologic cancer surgery can be performed without homologous blood in most cases.

Novel low‐molecular‐weight superoxide dismutase mimic deferoxamine‐manganese improves survival following hemorrhagic and endotoxic shock

AbstractThe purpose of this study was to demonstrate the in vivo activity of the novel low‐molecular‐weight superoxide dismutase (SOD)‐mimic deferoxamine‐manganese (Def‐Mn) in models of circulatory shock. Two forms of Def‐Mn were examined: the pink‐complex (NPC 14550) and the green complex (NPC 15823). Hemorrhagic shock was induced in rats (40 mmHg, 60 min) followed by autotransfusion of shed blood, and endotoxic shock (LPS, 200 μg/10g BW) was induced in mice. Significant lethality (ca. 20% survival rate at 24 hr) was observed in each model. Following hemorrhagic shock, NPC 14550 (10 mg/kg) increased the 24‐hr survival rate to 48% (P=0.03), while NPC 15823 (10 mg/kg) did not significantly alter survival rate (30%, P &gt; 0.05). Following endotoxin challenge, both NPC 14550 and NPC 15823 significantly improved the 24‐hr survival rate to 68% (P≤0.001) and 55% (P=0.002), respectively. Bovine erythrocyte SOD and polyethylene glycol‐SOD (Peg‐SOD) also afforded significant protection in these models and, as anticipated, SOD afforded transient protection, while Peg‐SOD provided significant protection for 24 hr and longer. Deferoxamine mesylate provided only transient protection. It is concluded that the SOD‐mimic Def‐Mn has beneficial effects following circulatory shock and, furthermore, these data provide additional evidence that the superoxide radical does play a role in these disorders.

Autotransfusion of unwashed mediastinal shed blood fails to decrease banked blood requirements in patients undergoing aortocoronary bypass surgery

Infusion of unwashed mediastinal shed blood (MSB) is one technique advocated for decreasing use of donor blood in cardiac surgery patients. A commercially available system was prospectively evaluated in 96 consecutive patients. The control group was comprised of 78 consecutive patients. All underwent elective aortocoronary bypass surgery. Student's t-test, chi-square analysis, multivariate analysis, and Fisher's exact test were used where appropriate. There was no decrease in the amount of banked blood required or percentage of patients who received transfusions in the MSB autotransfusion group.

Reflexogenic neuronal and humoral responses to selective stimulation of low-pressure cardiopulmonary receptors in man

This study was conducted to determine the relative importance of efferent muscle sympathetic nerve activity (MSA), vasopressin (ADH) and atrial natriuretic peptide (ANP) in the short-term neurohumoral response to moderate changes in low-pressure cardiopulmonary receptor activity. The low-pressure receptors were stimulated and unloaded, respectively, by autotransfusion of blood (450 ml) and the application of lower body negative pressure (LBNP, -20 mmHg), and in 11 healthy men we measured MSA in the left peroneal nerve, indirect blood pressure, ECG, central venous pressure (CVP) and venous plasma concentrations of ANP and ADH (radioimmunoassay). Total MSA rose by 30% during LBNP and decreased during a rapid autotransfusion of blood, and the changes in MSA were significantly related to changes in CVP. The plasma concentrations of ADH and ANP were not significantly affected by either procedure. It is suggested that during moderate short-term changes in venous return, MSA responded more rapidly and/or at a lower threshold than the ADH and ANP systems.

Bleeding complications associated with cardiopulmonary bypass

Bleeding after CPB has been difficult to characterize and its treatment equally difficult to standardize. The complexity of this problem is related to the hemostatic process, the technical variations in the operative procedures, and the many uncontrolled variables associated with CPB, including the effects of anesthetic or pharmacologic agents, the nature of the priming solution, hemodilution, hypothermia, the type of oxygenator, and the use of transfused blood products. Although there are multiple and generally predictable complex changes in the hemostatic mechanism during CPB, the temporary loss of platelet function is the most common and clinically relevant. This transient platelet dysfunction occurs in all patients undergoing CPB; however, it only causes excessive bleeding in a small percentage of patients. Unfortunately, it has not yet been possible to predict which patients will develop hemorrhagic complications, although prolonged pump times are a contributing risk factor. Over the past decade there has been extensive investigation into the management of bleeding associated with CPB, provoked primarily by the increased awareness of transfusion- transmitted viral diseases and the inappropriately excessive use of homologous blood products. Several approaches to autotransfusion of shed blood and autologus blood donation have been developed to minimize perioperative homologous blood transfusion. Pharmacologic agents such as desmopressin, aprotinin, and topical fibrin glues have also been introduced to improve hemostasis during CPB. The protease inhibitor aprotinin is particularly promising in the reduction of bleeding associated with CPB when given prophylactically. Aprotinin may provide new insights into the mechanism of CPB-induced platelet dysfunction. Desmopressin is indicated only for the treatment of bleeding after CPB. The management of bleeding associated with CPB will undoubtedly

Maternal hemodynamic effects of uterine contractions by M-mode and pulsed-Doppler echocardiography

Nineteen normotensive term gravid women were studied by M-mode and pulsed-Doppler echocardiography to noninvasively evaluate the hemodynamic consequences of uterine contractions on maternal left ventricular function. These laboring subjects were placed in the left lateral decubitus position with epidural labor anesthesia. Ejection fraction was not affected by firm contractions, although a small increase in left ventricular end-diastolic measurements was noted. There was a tendency for maternal heart rate to decrease (-5%); however, this trend was not statistically significant. A 16% increase in left ventricular stroke volume (75 ± 15 to 89 ± 17 ml) (p < 0.001) was associated with an overall 11% augmentation of maternal cardiac output (6.31 ± 1.79 to 7.12 ± 1.93 L/min) (p < 0.001). These findings support the hypothesis that uterine contractions increase maternal stroke volume through autotransfusion of uteroplacental blood and cardiac preload augmentation during normal labor.

当教室で経験した輸血後ＧＶＨＤの６症例

We experienced 6 patients with graft versus host disease (GVHD) after blood transfusion. Their age were 65, 70, 68, 65, 57 and 67 years old. There were 4 males and 2 females. GVHD was occured in 5 cases of cardio-vascular surgery and 1 case of orthopedic surgery. Although fresh blood was transfused to 5 patients, one patient was associated with GVHD after only stored red blood cells transfusion.In most cases, high fever and skin rush began within about 10 days after operation, and liver function abnormalities and bone marrow supression began within about 15-20 days after operation. In some cases, renal failure, gastrointestinal bleeding or disseminated intravascular coagulation was observed. They died of acute complications of the disease within 30-40 days, although they were complications of the disease within 30-40 days, although they were treated with streoid, methotrexate or antilymphocyte globulin.Blood transfusion should be carefully, and blood produce irradiation and auto-blood transfusion was recommended for prevention of posttransfusion GVHD.

Early experience of intraoperative autotransfusion.

Intraoperative autotransfusion of whole blood was performed using the Solcotrans device in 45 patients undergoing major vascular surgery or other procedures in which there was a clean operative field. Overall, 60% of the blood shed during these operations was reinfused. Approximately 50% of patients avoided the potential complications of homologous transfusion. There were no complications attributable to the use of this device although in a sample of 13 patients, 30% of the erythrocytes were haemolysed and there were other minor haematological abnormalities. In conclusion this device provides a simple method of autotransfusing 2 or 3 litres of blood aspirated from an uncontaminated operative field.

Autotransfusion of blood contaminated by enteric contents: a potentially life-saving measure in the massively hemorrhaging trauma patient?

The role of autotransfusion of shed blood is well established in thoracic, abdominal, vascular, and orthopedic elective surgery. When hollow viscera or infected organs are uninvolved, autotransfusion is also well accepted in trauma surgery. Less clear is whether shed blood from an injury violating hollow organs in the abdomen can be used safely in the trauma patient. We retrospectively identified 11 patients with penetrating thoracoabdominal trauma who had received enteric contaminated shed blood, processed by the Haemonetics Cell Saver, and reviewed their records for infectious morbidity or mortality. All patients received parenteral broad-spectrum antibiotics. Three patients developed infectious wound complications, one probably nosocomial from the intensive care unit. No patient developed intra-abdominal sepsis and no deaths were reported. Based on the results of this preliminary result, it may be appropriate to use autotransfusion of shed blood in trauma patients with gastrointestinal injuries, if banked blood is not readily available and the patients receive perioperative broad-spectrum antibiotics.

Autotransfusion of Drained Mediastinal Blood after Cardiac Surgery: a Reappraisal

In a randomised prospective study the efficacy of autotransfusion was investigated in two groups of 25 patients, a study group in which autologous blood was collected from the mediastinal tubes and retransfused, and a second, control group, in which only stored blood was used. In the study group, a reduction of 50% in the amount of stored blood required was observed. However, in two out of 25 patients the transfusion system could not be used due to clot formation in one of its components. From the total bloodloss per patient about 25% became available for autotransfusion. No significant differences between the two groups were found for hemoglobine, hematocrite, white blood count, platelets and fibrinogen level. Coagulation studies of the drain blood indicate that an active process of mediastinal clotting, followed by fibrinolysis occurs during the losing and collecting. The blood available for retransfusion contained a considerable amount of small-sized debris. It is concluded that autotransfusion of drain blood is not to be recommended for routine use.

Blood volume distribution in the Trendelenburg position

The Trendelenburg position is used frequently in treating hypotensive patients. It is believed that placing patients in the Trendelenburg position causes an autotransfusion of blood to the central circulation. No published studies document the volume of blood displaced centrally. In our study ten volunteers were placed in the Trendelenburg position. Blood volumes were determined from body surface area, and radionuclide scanning was used to determine blood volume distribution. Placing normovolemic volunteers in the Trendelenburg resulted in a 1.8% (median) displacement of the total volume centrally. The autotransfusion of blood produced by the Trendelenburg position is small and is unlikely to have an important clinical effect.

Renal response to lower body positive pressure produced by military anti-shock trousers.

Military anti-shock trousers (MAST) are extensively used in the management of various forms of clinical shock and are presumed to produce their antihypotensive effect by the autotransfusion of blood from the lower extremities. In the present studies we documented the renal response to (1) four hours of recumbency; (2) 4 h of MAST inflation at a pressure of 45 mm Hg over the lower extremities and 15 mm Hg over the abdomen, and (3) 4 h of thermoneutral head-out water immersion in a group of salt replete normal subjects. Similar studies were performed in a group of adults with nephrotic syndrome and edema. In both normal and nephrotic subjects only water immersion produced a natriuresis that was significantly greater than during recumbency. The mean natriuresis following MAST inflation in normal subjects was somewhat greater than that during recumbency but the difference was neither consistent nor statistically significant. We conclude that MAST inflation does not lead to central translocation of more fluid than what would be expected from the assumption of recumbent posture. Thus, MAST are unlikely to be of therapeutic benefit in the relief of edema in patients with nephrotic syndrome and a critical evaluation of their mechanisms of action in the management of hypotension is required.