Autotransfusion Research Articles

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

Autotransfusion in low-resource settings: a scoping review

IntroductionGlobally, haemorrhage is the leading cause of both maternal mortality and preventable trauma death. For patients suffering from haemorrhage, prompt blood transfusion can be life-saving; however, safe and sufficient blood...

550 Autotransfusion of vaginally shed blood during obstetric hemorrhage: a matched cohort atudy

Cell salvage and autotransfusion (AT) has gained acceptance as an effective tool for management of hemorrhage during cesarean delivery. However, most obstetric hemorrhage (OBH) occurs following vaginal delivery. Given concern for contamination of vaginally shed blood, AT for management of OBH following vaginal delivery has not been as widely adopted. We aimed to determine the efficacy and safety of AT for vaginal deliveries complicated by OBH. This is a single center retrospective matched cohort study of vaginal deliveries complicated by OBH from 2014-2020. Patients that received AT for OBH following vaginal delivery were each matched to 4 controls that delivered vaginally with an EBL within 200 mL. Our cohort was limited to EBL below 2400 mL, because cell salvage was consistently utilized above this threshold. The primary outcome was allogeneic transfusion of packed red blood cells (RBCs). Unadjusted analyses were performed using Fisher’s exact test and Student’s paired t test. Adjusted analyses were performed using multivariable logistic and linear regression. During the study period, 36 AT patients were matched to 144 unexposed controls. AT patients were more likely to be a patient of MFM, identify as Non-Hispanic Black, have preeclampsia, and use tobacco. There was no significant difference in transfusion of packed RBCs when AT cases were compared to controls (OR 1.2; 95% CI 0.6-2.7, p=0.5, AT referent). No AT patients were transfused ≥ 4 units of packed RBCs compared to 3.3% of controls (n=6; p=0.601). Notably, AT patients had a less drastic decline in hemoglobin compared to controls across all values of EBL (p=0.003; Figure 1). There were no detectable differences in venous thromboembolism events or rates of individual or composite infectious, pulmonary or renal complications (Table 1). Our data suggest that cell salvage and autotransfusion of vaginally shed blood is a safe and effective tool for management of obstetric hemorrhage following vaginal delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparison of Superior Vena Cava and Inferior Vena Cava Diameter Changes by Echocardiography in Predicting Fluid Responsiveness in Mechanically Ventilated Patients.

Context:Resuscitation of critically ill patients requires an accurate assessment of the patient's intravascular volume status. Passive leg raise cause auto transfusion of fluid to the thoracic cavity.Aims:This study aims to assess and compare the efficacy of superior vena cava (SVC) and inferior vena cava (IVC) diameter changes in response to passive leg raise (PLR) in predicting fluid responsiveness in mechanically ventilated hemodynamically unstable critically ill patients.Methods:We enrolled 30 patients. Predictive indices were obtained by transesophageal and transthoracic echocardiography and were calculated as follows: (Dmax − Dmin)/Dmax for collapsibility index of SVC (cSVC) and (Dmax − Dmin)/Dmin for distensibility index of IVC (dIVC), where Dmax and Dmin are the maximal and minimal diameters of SVC and IVC. Measurements were performed at baseline and 1 min after PLR. Patients were divided into responders (increase in cardiac index (CI) ≥10%) and nonresponders (NR) (increase in CI <10% or no increase in CI).Results:Among those included, 24 (80%) patients were R and six were NR. There was significant rise in mean arterial pressure, decrease in heart rate, and decrease in mean cSVC from baseline to 1 min after PLR among responders. The best threshold values for discriminating R from NR was 35% for cSVC, with sensitivity and specificity of being 100%, and 25% for dIVC, with 54% sensitivity and 86.7% specificity. The areas under the receiver operating characteristic curves for cSVC and dIVC regarding the assessment of fluid responsiveness were 1.00 and 0.66, respectively.Conclusions:cSVC had better sensitivity and specificity than dIVC in predicting fluid responsiveness.

The blood protective effect of autologous platelet separation in aortic dissection.

This study aimed to retrospectively analyze the blood protective effect of autologous platelet separation in operations for acute aortic dissection. A total of 130 patients with acute aortic dissection were enrolled into the present study. The average age of these patients was 52.962±10.5061 years old. These patients underwent the modified aortic arch replacement with the elephant trunk technique or endovascular aortic exclusion with covered stent. Among these patients, 68 patients who underwent autologous platelet separation were assigned to the platelet separation group, while the remaining patients were assigned to the control group. All operations were performed under deep hypothermic circulatory arrest. After anesthesia, 1-2 therapeutic doses of autologous platelets were isolated from patients in the platelet separation group, and these platelets were quickly infused back to these patients after heparin was neutralized by protamine at the end of the cardiopulmonary bypass. The preoperative and postoperative indexes in these two groups were compared. There were no statistically significant differences in age, gender, smoking history, drinking history and hypertension history between these two groups. Compared with controls, the transfusion volume of allogeneic platelets in the perioperative period significantly decreased in the platelet separation group (1.919±1.6226 vs. 0.794±1.1789, P < #x003C;< #x200A;0.05), and the use rate of allogeneic platelets also significantly decreased (74.19% vs. 45.59%, P < #x003C;< #x200A;0.05). The intraoperative auto transfusion of platelets significantly reduced the volume of allogeneic platelet transfusion after the operation for aortic dissection, which has a significant blood protective effect.

Outcomes of autologous blood collection prior to bone marrow harvest for matched unrelated donors.

e18535 Background: Autologous (auto) blood collection prior to bone marrow (BM) harvest is a common procedure however there is little data to say whether this is beneficial. Methods: This is a retrospective study evaluating the efficacy of pre-op auto blood collection in healthy unrelated donors who underwent BM harvesting at our institution between 9/2009 and 8/2017. Unrelated donors aged 18 or older who underwent their first BM harvest were included. Comparisons were made using two sample t-tests. Results: Among the 73 BM donors, 54 (74%) underwent auto blood collection resulting in 78 units collected. The cohorts with and without auto blood collected were similar in age and gender (mean age 31.0 vs 30.2; female 59% vs 41%). Those with auto blood collected donated larger volumes of marrow (mean 1395 mL vs 799 mL, p = 0.0002). Baseline hemoglobin (Hb) was similar between the cohorts (mean 14.1 g/dL vs 14.0 g/dL, p = 0.87). However, those with auto blood collected had lower pre-harvest (mean 13.1 g/dL vs 13.8 g/dL, p = 0.0430) and post-harvest Hb (mean 10.0 g/dL vs 11.3 g/dL, p = 0.0120). Of the 78 auto blood units collected, 45 units (58%) were used with 92% of women and 56% of men receiving their auto blood post-op. 33 (42%) auto blood units were discarded. Donors who were given back their auto blood were more likely to be female and have lower pre- and post-harvest Hb. Reasons for auto blood transfusion were blood availability (31%), donor post-op symptoms (i.e. hypotension, dizziness, syncope, and bleeding; 23%), intra-operative transient hypotension (26%), post-op anemia (11%) and patient request (9%). None of the patients who were transfused auto blood, or donors without auto blood collection, required allogeneic blood. Conclusions: Based on our results, collection of auto blood prior to bone marrow harvest leads to lower pre-op Hb and increases the likelihood of post-op blood transfusion. In addition, availability of auto blood can lead to over transfusion which may be detrimental to donor health. Although there may be a subset of donors who might benefit, routine auto blood collection prior to bone marrow harvesting is unnecessary and can be potentially hazardous to donors.

Optimal Management of a Pregnant Patient with Rheumatic Heart Disease

Rheumatic heart disease remains the number one worldwide cause of maternal cardiac complications in pregnancy.1 Since symptoms of rheumatic fever typically do not present until the fourth or fifth decade, the pathophysiologic changes associated with pregnancy may cause as many as 25% of these women to first experience symptoms during pregnancy. For this reason, it is important that obstetric anesthesiologists remain aware of the disease, its complications, and management of valvular lesions throughout the birthing process. The normal physiologic changes of pregnancy cause unique problems to the mother with underlying cardiac disease.2 Intravascular volume and cardiac output (CO) increase while systemic vascular resistance (SVR) decreases to preserve normal mean arterial pressure (MAP). During labor, each uterine contraction results in an auto transfusion of blood, resulting in even higher CO.3 Likewise, pain and apprehension can lead to sympathetically mediated increases in SVR, heart rate (HR), and CO causing further stress.2 Yet, the greatest stress comes immediately after delivery when uterine contraction and involution can increase CO by as much as 80% above third trimester values.3 With all these changes, one must realize how valvular disease is affected during pregnancy. In general, regurgitant lesions are tolerated better due to the increase in intravascular volume and the decrease in SVR, thus improving forward flow of blood through the valves.2,3 In contrast, stenotic lesions are tolerated poorly due to the inability to increase CO through a stenotic valve in the setting of increased intravascular volume and increased preload.2 In patients with rheumatic heart disease, mitral stenosis is the most common heart lesion.1 When these patients become pregnant, the hypervolemia and increased HR can increase the transmitral pressure gradient, leading to increased left atrial volume and pressure. Pressure can be transmitted to the pulmonary vasculature, resulting in pulmonary edema and in severe cases pulmonary hypertension, a significant risk during pregnancy as it can cause right heart failure.4 Further, the chronically dilated left atrium has a propensity to disrupt the cardiac conducting system and cause supraventricular tachycardia, 1 a detrimental event in patients with mitral stenosis who rely on the atrial kick to augment preload. Overall, these factors often cause the previously undiagnosed and asymptomatic patient to develop symptoms during pregnancy, and, in severe cases, experience profound cardiac decompensation.

Effects of blood conservation management on rapid rehabilitation in patients undergoing total hip replacement

Objective To explore the effects of blood conservation management on rapid rehabilitation in patients with total hip replacement. Methods A total of 120 patients who have undergone primary unilateral total hip replacement from November 2016 to June 2017 in the People's Hospital of Guangxi Zhuang Autonomous Region were selected and randomly divided into experimental group and control group, with 60 cases in each group. The patients in the control group were given hemostatic drugs and routine nursing care during perioperative period. The experimental group was treated with rapid rehabilitation nursing during perioperative period under blood protection management, including the protection of core body temperature, blood dilution, hemostatic, autotransfusion, controlled hypotension, iron drugs. The intraoperative blood transfusion rate, blood loss, postoperative drainage, the removal time of drainage tube and the average length of hospitalization were compared between two groups. Results The blood transfusion rate of the experimental group was 3.33%, and that of the control group was 26.67%, with statistical significance (χ2=12.810, P<0.01) . In the experimental group, the amount of intraoperative blood loss was (240.86±65.78) ml, postoperative drainage (433.95±72.26) ml, the removal time of drainage tube was (36.2±6.5) h and the average hospitalization day was (6.9±2.1) , which were all lower than those of the control group [ (320.32±70.48) ml, (511.71±85.66) ml, (50.4±2.8) h, (8.1±3.4) d], and the differences were statistically significant (t=-3.659, 3.800, -2.860, 3.800; P<0.01) . Conclusions The application of rapid rehabilitation surgery blood protection management in patients with total hip replacement during the perioperative period is significant, which is beneficial to the early rehabilitation of patients, and opens a new concept for the rapid rehabilitation of joint replacement surgery. Key words: Arthroplasty, replacement, hip; Perioperative nursing; Rapid rehabilitation surgery; Blood management

Effect and safety of intraoperative cell salvage during cesarean section

Objective To assess the safety and effect of intraoperative cell salvage (ICS) during cesarean section. Methods This was a case-control study in which 60 gravidas who received ICS (ICS group) and 60 gravidas who received allogenic transfusion (control group) during caesarean section in Obstetrics and Gynecology Hospital of Fudan University during January 2014 to December 2016 were enrolled. Subjects in the two groups were matched in age, gestational age, gestational complications (placenta increta, placenta previa, scarred uterine, leiomyomas and anemia) and hemorrhagic volume during cesarean section. Several indicators including complications of transfusion, postoperative recovery, expense of transfusion, as well as the complete blood count and body temperature before and after operation were compared between the two groups. T, rank-sum or Chi-square test was used for statistical analysis. Results (1) No significant difference in age, gestational age, twin gestation, complications, preoperative body temperature, or the volume of hemorrhage or transfusion was observed between the two groups (all P>0.05). (2) The autotransfusion volume was 385 (161-583) ml in the ICS group. Fifteen cases (20.0%) in the ICS group also received additional transfusions of leukocyte-reduced red blood cell (RBC) suspension, fresh frozen plasma and cryoprecipitate and two cases (3.3%) received additional transfusions of leukocyte-reduced RBC suspension and fresh frozen plasma. The two groups showed no significant difference in the cost of transfusion or per-capita transfusion volume of fresh frozen plasma or cryoprecipitate. However, the transfusion volume of leukocyte-reduced RBC suspension was lower in the ICS group as compared with that in the control group [M (P25-P75), 1.9 (1.5-4.5) vs 4.1 (2.8-6.2) U, Z=-2.800, P=0.005]. (3) There was no significant difference in complete blood count or coagulation function between the two groups before the operation. White blood cell (WBC) counts in the two groups were elevated following operation. Postoperative WBC count in the control group was higher than that in the ICS group, while the levels of RBC and hemoglobin were lower than those in the ICS group following operation (all P<0.05). (4) No amniotic fluid embolism was reported in the two groups. Only one case of rash was reported in the ICS group, which was fewer than the transfusion reactions occurred in the control group [1.7% (1/60) vs 13.3% (8/60), χ2=5.886, P=0.016]. (5) The two groups showed no significant difference in preoperative temperature, the highest temperature within three days after operation or incision healing. Compared with the patients in the control group, those in the ICS group had shorter hospital stay [(4.7±1.1) vs (6.3±1.8) d, t=3.341, P<0.05]. Conclusion ICS is a safe and effective measure for gravidas at higher risk of hemorrhage during cesarean section. Key words: Blood transfusion, autologous; Cesarean section; Intraoperative period

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

Clinical outcome and inflammatory response after transfusion of washed and unwashed red blood cells in children following cardiovascular surgery

Children frequently require red blood cell transfusion after cardiac surgery, which can generate an inflammatory response that is associated with increased morbidity and mortality. The aim of this study was to evaluate the inflammatory response and clinical effect of RBC transfusion in children.In a pediatric prospective controlled clinical trial 48 children were randomized to an unwashed or washed red blood cell transfusion group after cardiac surgery. Red blood cells were washed using an auto transfusion device with blood gas analyses of the packed red blood cells performed before transfusion. Vital parameters, blood analyses, and plasma concentrations of cytokines were measured before and 24h after transfusion.Forty-five children were included with 23 receiving unwashed and 22 washed red blood cells. Washing reduced hemoglobin, potassium, and glucose while increasing sodium concentration in the packed red blood cells. Increased levels of hemoglobin, hematocrit, and erythrocyte counts were observed in both groups after transfusion. Increased levels of cytokine expression (IL-1α, IL-6, IL-8, MCP-1, and TARC) were detected in the group receiving unwashed red blood cells, while IL-8 levels were reduced in patients receiving washed red blood cells. Also, the percentage increase of cytokine concentrations (IL-6, IL-8, MCP-1, and GP-VI) before in comparison to after transfusion was lower in patients receiving washed red blood cells.No significant differences in clinical outcome parameters were observed between the two groups.Transfusion of red blood cells induces a pro-inflammatory reaction which can be diminished by washing the red blood cells before transfusion. Further clinical trials with larger patient cohorts receiving multiple transfusions are needed to better evaluate the clinical outcome.

The provision of pediatric cardiac anesthesia services in Germany: current status of structural and personnel organization.

Anesthesia for pediatric cardiac surgery requires a high level of expert knowledge. There are currently no recommendations and standards for anesthetic management for congenital cardiac surgery in Germany. The aim of the present study was to assess the current status of structural and personnel anesthetic standards at pediatric cardiac surgery centers in Germany. All cardiac surgical centers in Germany were reviewed for an active program for congenital heart surgery. Centers with an active program were invited to respond to an online survey. The questionnaire containing 55 items in 16 categories assessed current practice in pediatric cardiac anesthesia. An active program for pediatric cardiac surgery was identified at 27 centers. The response rate to the survey was 96.3%. A specialized group of anesthesiologists for pediatric cardiac anesthesia was reported from 26 centers (92.3%). The mean size of this group was 4.8 anesthesiologists per center. However, the annual case load of centers and relative annual case load per specialized anesthesiologist varied considerably between 12.5 and 250. Nonanesthesiologists performed sedation and general anesthesia for diagnostic and therapeutic interventions outside the operating theater in children with congenital heart diseases in 24 centers (77%). Although special equipment, for example, pediatric TEE, near-infrared spectroscopy, and devices for mechanical auto transfusion were available in most centers, their routine use was not always part of standard operating procedures. The proposal for mean adequate training in pediatric cardiac anesthesia as estimated by the participating centers was 10.8months. The present study represents the current structural situation for anesthesia at German pediatric cardiac surgery centers.

Guidelines and consensus: statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute.

Editor: We read with interest the 2015 Statement on Pregnancy in Pulmonary Hypertension from the Pulmonary Vascular Research Institute.1 It aimed to provide evidence-based guidelines for the management of pregnancies complicated by pulmonary hypertension. Specifically, the authors staunchly recommend cesarean delivery between 34 and 36 weeks gestation as the preferred mode of delivery. The authors assert that cesarean delivery “bypasses the hemodynamic complications associated with labor… and also the auto transfusion associated with vaginal contractions.” p45 We find fault with both this recommendation and its justification, and we are troubled that the authors obtained limited obstetric input (only 1 of the 9 authors was affiliated with a department of obstetrics) and did not utilize specialty and interdisciplinary working groups when drafting pregnancy-related guidelines. We assert that route and timing of delivery in the setting of pulmonary hypertension complicating pregnancy remains controversial. Although recent management trends favor planned cesarean delivery, there is little evidence that cesarean delivery improves maternal outcomes over vaginal delivery.2,3 Although cardiac output can increase by up to 25% in active labor and by 50% during maternal pushing efforts, assisted second-stage labor and laboring in the lateral decubitus position can both greatly offset these changes.4 Moreover, cardiac output in the postpartum period can increase by as much as 80% regardless of delivery route. It is also relevant to consider that induction of regional anesthesia for cesarean delivery can result in hypotension in up to 30% of cases.4 Overall, cesarean delivery results in higher rates of severe maternal morbidity and mortality, including higher rates of death, hemorrhage, shock, cardiac arrest, renal failure, venous thromboembolic event, and infection.5 Both the severity of pulmonary disease and the woman's pregnancy history must be considered in any delivery recommendation. A woman with mild, stable pulmonary hypertension is very different from one with severe right ventricular failure requiring, for example, parenteral prostanoid or nitric oxide therapy. Likewise, an urgent cesarean delivery involving a multiparous woman presenting in rapidly progressive labor can cause more harm than vaginal delivery. Successful management of the gravid woman with pulmonary hypertension requires a multidisciplinary team comprising individuals from obstetrics, anesthesiology, and neonatology departments, as well as a pulmonary hypertension specialist, working with experienced support staff. We advocate for an individualized delivery plan taking relevant maternal and pregnancy characteristics into consideration.

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

Reliability of different parameters for rapid bedside evaluation of clearance rates of salvaged blood

Objective To evaluate the reliability of the clearance rates of free hemoglobin (fHb), K+ and Ca2+ for rapid bedside evaluation of the clearance rates of the salvaged blood. Methods Twenty-six patients of both sexes, aged 18-80 yr, with body mass index<32 kg/m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective surgery requiring autologous blood withdrawal-reinfusion, were involved in this study. An autotransfusion device (continuous autotransfusion system, Fresenius) was used to collect the blood shed from the surgical field and to process the salvaged blood during the surgery. The clearance rates of albumin (Alb), fHb, K+ and Ca2+ were detected in three washing modes (big flux, standard, high quality). Results Compared with the clearance rate of Alb, the clearance rates of K+ ( 0.05). There was no significant difference in the clearance rates of each parameter between the three washing modes(P>0.05). Conclusion When the autotransfusion device continuous autotransfusion system is used to collect the blood, the clearance rates of fHb and Ca2+ can be used as parameters for rapid bedside evaluation of the clearance rates of the salvaged blood, while Ca2 + detection is more convenient, and therefore it is superior to fHb. Key words: Blood transfusion, autologous; Point-of-care systems; Elimination rate

Risk Factors and Prognosis of Ruptured Ectopic Pregnancy in University Hopital of Benin

Aim: The aim was to study the risk factors and prognosis of ruptured ectopic pregnancy. Method: We conducted a retrospective and descriptive study about ruptured ectopic pregnancy at the university clinic of gynecology and obstetric, over a period of 05 years (01/01/2009 to 31/12/2013). Data collection was done by a count of records using a questionnaire developed for this purpose. A total of 336 cases were recorded and analyzed by EPI Data Version 3.1. Results: The overall incidence of ectopic pregnancy was 1.89% and 88.69% of cases were ruptured. The average age was 28 years. The most affected age group was between 20 and 29 years. They were mainly married women (43.62%), nulliparous and pauciparous (53.36%). The most contributing risk factor was history of genital infections (45.31%). 81.54% of patients were referred from a peripheral center. The highest number of ruptured ectopic pregnancy occurred between 7 and 10 weeks of gestation (39.6%). 92.95% of patients underwent radical surgery with total salpingectomy. 56.71% among the latter underwent per operative auto transfusion. The prognosis was marked by one death (0.4%). Conclusion: Ruptured ectopic pregnancy is one of the causes of morbidity and maternal death.

Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe.

The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax. This is a multi-institutional retrospective study of all trauma patients who received autologous whole blood transfusion from hemothorax from two Level I trauma centers. Patients who received AT were matched to patients who did not receive AT (No-AT) using propensity score matching in a 1:1 ratio for admission age, sex, mechanism, type of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, systolic blood pressure, heart rate, hemoglobin, international normalized ratio (INR), prothrombin time, partial prothrombin time, and lactate. AT was defined as transfusion of autologous blood from patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorous dextrose. Outcome measures were in-hospital complications, 24-hour INR, and mortality. In-hospital complications were defined as adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal insufficiency, and transfusion-related acute lung injury. A total of 272 patients (AT, 136; No-AT, 136) were included. There was no difference in admission age (p = 0.6), ISS (p = 0.56), head Abbreviated Injury Scale (AIS) score (p = 0.42), systolic blood pressure (p = 0.88), and INR (p = 0.62) between the two groups. There was no significant difference in in-hospital complications (p = 0.61), mortality (p = 0.51), and 24-hour postadmission INR (0.31) between the AT and No-AT groups. Patients who received AT had significantly lower packed red blood cell (p = 0.01) and platelet requirements (p = 0.01). Cost of transfusions (p = 0.01) was significantly lower in the AT group compared with the No-AT group. The autologous transfusion of the patient's shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study. It also reduced the need for allogeneic transfusions and decreased hospital costs. This study demonstrates safety data that would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective. Epidemiologic/prognostic study, level III.

In brief

Study Objective: To analyze intraoperative autologous salvage of shed mediastinal blood and subsequent transfusion in cardiac surgery.Design: Retrospective statistical analysis.Setting: University hospital.Patients: Three thousand twenty two patients undergoing cardiac surgery from 1984 to 1988.Interventions: A review of anesthesia and transfusion records of all patients who underwent intraoperative salvage of shed blood and autologous transfusion using the Sorenson Receptal Auto Transfusion System (ATS) with saline wash prior to reinfusion in cardiac surgery.Measurements and Main Results: The salvaged blood volume ranged from 36 to 2,795 ml, with a mean of 321 ± 222 ml (SD). Eighteen percent of patients did not receive any homologous blood products during their hospitalization. Patients who received only salvaged autologous transfusion were younger, had higher preoperative hemoglobin and hematocrit values, had a larger body surface area, and had shorter surgeries compared with patients who received only homologous blood or both autologous and homologous blood. More blood products were given to patients who received salvaged autologous blood compared with those who did not. Patients who underwent normovolemic hemodilution prior to extracorporeal circulation with subsequent reinfusion received significantly fewer blood products. Ten preoperative and, four intraoperative variables significantly influenced the salvaged volume. Previous cardiac surgery was the most significant preoperative variable, and repair of ventricular septal defect produced by myocardial ischemia was the most significant intraoperative variable.Conclusion: Considering the average salvaged volume and its current autologous transfusion-related expense, autologous blood salvage is potentially an economic benefit. Perioperative blood conservation requires a considerable commitment from surgeons, anesthesiologists, perfusionists, and intensive care physicians to be effective.

Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty.

Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Retrospective comparative study. Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

Effects of washed autologous blood transfusion on erythrocytic fragility in salvaged blood from diabetics

To explore the effects of washed autologous blood transfusion on the recovery and hemolysis of erythrocytes from diabetic patients subjected to off-pump coronary artery bypass grafting (OP-CABG). A total of Sixty patients were included in this study. The patients were assigned as two groups:control (C, n = 30) , and diabetic group (D, n = 30). Samples were taken from preoperation, prior to and after disposal of centrifuging and washing to determine the recovery and fragility of erythrocytes. Free hemoglobin and extracellular potassium were measured at 0, 4, 6, 12, 24 h after washing. The erythrocytic recovery did not have significant difference between two groups (C group 82.6% ± 5.6%,D group 80.9% ± 6.2%, P > 0.05) .Under the same processing, the erythrocyte fragility in the diabetic group were significantly higher than the control group in preoperation and before washing (Preoperation 0.36%: D group 84.9% ± 6.7% C group 78.7% ± 4.6%, P = 0.003; Preoperation 0.68%: D group 9.0% ± 4.5% C group 1.9% ± 0.8%, P = 0.000; Before washing 0.36%: D group 80.6% ± 4.9% C group 78.0% ± 5.8%, P = 0.000; Before washing 0.68%: D group 11.0% ± 3.4% C group 2.4% ± 0.9%, P = 0.000). However, after washing there were no significant differences of erythrocyte fragility between groups. Free hemoglobin and blood potassium at 4, 6, 12, 24 h after washing were significantly increased (P < 0.05) in a time-dependent manner in the two groups. But there was no obvious difference in the interior-group at the same time point. Autotransfusion has no significant extra damage on erythrocytes from diabetic patients undergoing OP-CABG, and the salvaged blood should be transfused as soon as possible to reduce hemolysis.