Intraoperative Autologous Blood Transfusion Research Articles

Construction and validation of a nomogram for blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures in the elderly: a cross-sectional study

PurposeFew studies have focused on the risk factors leading to postoperative blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures (PHFs) in the elderly. Therefore, we designed this study to explore potential risk factors of blood transfusion after ORIF for PHFs. We have also established a nomogram model to integrate and quantify our research results and give feedback.MethodsIn this study, we retrospectively analyzed the clinical data of elderly PHF patients undergoing ORIF from January 2020 to December 2021. We have established a multivariate regression model and nomograph. The prediction performance and consistency of the model were evaluated by the consistency coefficient and calibration curve, respectively.Results162 patients met our inclusion criteria and were included in the final study. The following factors are related to the increased risk of transfusion after ORIF: time to surgery, fibrinogen levels, intraoperative blood loss, and surgical duration.ConclusionsOur patient-specific transfusion risk calculator uses a robust multivariable model to predict transfusion risk.The resulting nomogram can be used as a screening tool to identify patients with high transfusion risk and provide necessary interventions for these patients (such as preoperative red blood cell mobilization, intraoperative autologous blood transfusion, etc.).

Intraoperative autologous blood transfusion: a systematic review of the literature

Bleeding of the main health problems is intraoperative in hospitals, mainly. Control of adequate oxygen is essential for tissue oxygen. Autologous blood transfusion is used as a strategy to reduce the possibility of negative effects of allo transfusion and in situations of lack of donated blood. The aim of the study is to determine the importance and advantages of intraoperative autologous transfusion through a systematic review of studies addressing autotransfusion, published between 2016 and Busca2021. In studies, autotransfusion was mainly indicated in critically ill patients with massive bleeding induced by chest trauma associated with hemorrhagic shock, requiring emergency blood transfusion, where it is not possible to wait for blood preparation or where blood is lacking. In addition, its use has been reported in orthopedic surgeries such as total hip and knee arthroplasty. As benefits of lack of resources: reduction of benefits treatment resources, reduction of the need for local finance resources. No related complications were observed. In conclusion, despite the various advantages of autologous transfusion, published articles on the subject are still scarce. Thus, it is necessary to carry out clinical trials that compare the two methods, for the eligibility of the different perspectives of clinical application of each method in the trauma scenario.

Blood management in patients with uterine myoma and anemia in the perioperative period

Introduction. In the structure of gynecological diseases, uterine myoma occupies one of the leading places and is accompanied by abnormal uterine bleeding, anemia, hemodynamic and hemostasiological disorders. Purpose. To optimize the management of the perioperative period in patients with uterine myoma and iron deficiency anemia (IDA) using methods of patient blood management (PBM). Materials and methods. The study group consisted of 94 patients with uterine myoma and IDA, who were examined and treated at the Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology. Of these, 74 patients made up the first, prospective group, who received IDA treatment with intravenous administration of ferric carboxymaltose during the perioperative period and during surgical treatment (laparoscopy / laparotomy and myomectomy), they underwent intraoperative autologous blood transfusion (IABT) using the cell salvage with Cell Saver 5+ apparatus. 20 women with myoma uterine and IDA constituted a comparison group (retrospective) who did not receive intravenous iron therapy in the perioperative period and did not undergo IABT. During surgical intervention (laparoscopy / laparotomy and myomectomy) or in the postoperative period, they received transfusion of donor erythrocyte-containing blood components according to indications. Results. All patients underwent surgical treatment in the amount of laparoscopy / laparotomy and myomectomy. During the operation, 74 patients of the main group underwent IABT in an average volume of 467.4 ± 327.8 ml. In the postoperative period, the patients of the main group continued to receive anemia therapy with intravenous administration of ferric carboxymaltose. And blood transfusions were not required in any patient of the main group. In patients of the second group, two (10 %) patients received donor erythrocyte suspension in an average volume of 358.2 ± 85.8 ml. Infectious and inflammatory complications: fever, inflammation of the postoperative suture, parametritis occurred in 6.8 % of women in the main group; in the comparison group – in 15 % of patients. Conclusions. Introduction into clinical practice of modern methods of blood management in patients with uterine myoma and IDA: the Infusion of intravenous high-dose ferric preparationsin the perioperative period, the use of Cell Saver devices for intra-operative autologous blood transfusion, helps to reduce the time of therapy, minimize transfusions of donor erythrocytes, reducing the frequency of infectious and inflammatory complications.

Intraoperative Cell-Saver Caused More Autologous Salvage Hemolysis in a Hereditary Spherocytosis Patient Than in a Normal Erythrocyte Patient.

Hereditary spherocytosis is a common red blood cell disease caused by an inherited red blood cell membrane defect, leading to a spherical shape and propensity for hemolysis. There is a lack of reports on intraoperative autologous blood transfusion for hereditary spherocytosis patients. We hereby report our recent experience with using the Cell Saver® system for intraoperative red blood cell salvage on a hereditary spherocytosis patient. There was a drastic increase in salvaged blood free-hemoglobin compared with the preoperative sample (82.6 mg/dl vs. 6.2 mg/dl) which indicated severe hemolysis. Although our patient recovered smoothly with a normal liver and renal function test and reported no adverse reaction during follow-up, it is noteworthy that severe hemolysis could happen during the cell salvage process for patients with hemolytic anemia, as there are similar reports on sickle cell anemia, beta-thalassemia intermedia, and paroxysmal nocturnal hemoglobinuria. Therefore, more clinical attention and thorough research should be drawn into this perspective, namely, hemolysis during the red blood cell salvage process for patients with hemolytic anemia.

Impact of intraoperative allogenic and autologous transfusion on immune function and prognosis in patients with hepatocellular carcinoma.

The effect of intraoperative blood transfusion on the immune function and prognosis of hepatocellular carcinoma (HCC) has not been fully investigated. The aim of this study was to evaluate the effects of intraoperative autologous blood transfusion and allogeneic blood transfusion on immune function and prognosis in surgically treated HCC patients. One hundred fourteen primary hepatic carcinoma patients who would undergo selective operations were divided into two groups, 35 patients in the experimental group received intraoperative autologous blood transfusion and 79 patients in the control group received allogeneic blood transfusion. The amount of serum T lymphocyte subsets, natural killer (NK) cells and immunoglobulin before and after operation, as well as the recurrence-free survival (RFS) were compared. Results shown that, there was no significant difference in the level of immunocytes and immunoglobulin between the two groups before treatment (P > .05). At 1 day after surgery, there were significant differences in T lymphocyte, NK cells and immunoglobulin levels before and after transfusion. CD3+, CD4+, CD4+/CD8+, and NK cells in autologous transfusion group were significantly higher than those in allogeneic transfusion group (P < .05); the level of IgG, IgM, and IgA in allogeneic transfusion group were significantly lower than those before operation (P < .05), the level of IgG, IgM, and IgA in autologous transfusion group did not significantly fluctuate, and significantly higher than those of allogeneic transfusion group (P < .05). At 5 days after surgery, all indexes of autologous transfusion group recovered to the preoperative level, the levels of CD3+, CD4+, CD4+/CD8+, NK cells, IgG, IgM, and IgA were significantly higher than those of allogeneic transfusion group (P < .05). The follow-up results showed that the RFS of autologous transfusion group was significantly higher than that of allogeneic transfusion group (P < .05). In conclusion, compared with allogeneic blood transfusion, intraoperative autologous blood transfusion possessed less impact on immune function, it may even improve immune function and RFS in HCC patients after surgery. Therefore, HCC patients should be recommended to receive autologous blood transfusion instead of allogeneic blood transfusion when they need blood transfusion during the perioperative period.

Independent Association Between Type of Intraoperative Blood Transfusion and Postoperative Delirium After Complex Spinal Fusion for Adult Deformity Correction.

Retrospective cohort study. To determine whether type of intraoperative blood transfusion used is associated with increased incidence of postoperative delirium after complex spine fusion involving five levels or greater. Postoperative delirium after spine surgery has been associated with age, cognitive status, and several comorbidities. Intraoperative allogenic blood transfusions have previously been linked to greater complication risks and length of hospital stay. However, whether type of intraoperative blood transfusion used increases the risk for postoperative delirium after complex spinal fusion remains relatively unknown. The medical records of 130 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (more than or equal to five levels) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. We identified 104 patients who encountered an intraoperative blood transfusion. Of the 104, 15 (11.5%) had Allogenic-only, 23 (17.7%) had Autologous-only, and 66 (50.8%) had Combined transfusions. The primary outcome investigated was the rate of postoperative delirium. There were significant differences in estimated blood loss (Combined: 2155.5 ± 1900.7 mL vs. Autologous: 1396.5 ± 790.0 mL vs. Allogenic: 1071.3 ± 577.8 mL vs. None: 506.9 ± 427.3 mL, P < 0.0001) and amount transfused (Combined: 1739.7 ± 1127.6 mL vs. Autologous: 465.7 ± 289.7 mL vs. Allogenic: 986.9 ± 512.9 mL, P < 0.0001). The Allogenic cohort had a significantly higher proportion of patients experiencing delirium (Combined: 7.6% vs. Autologous: 17.4% vs. Allogenic: 46.7% vs. None: 11.5%, P = 0.002). In multivariate nominal-logistic regression analysis, Allogenic (odds ratio [OR]: 24.81, 95% confidence interval [CI] [3.930, 156.702], P = 0.0002) and Autologous (OR: 6.43, 95% CI [1.156, 35.772], P = 0.0335) transfusions were independently associated with postoperative delirium. Our study suggests that there may be an independent association between intraoperative autologous and allogenic blood transfusions and postoperative delirium after complex spinal fusion. Further studies are necessary to identify the physiological effect of blood transfusions to better overall patient care and reduce healthcare expenditures. 3.

Application of intraoperative red cell salvage and autologous blood transfusion in cesarean section of pregnant women with central type of placenta previa

Objective To observe the safety and effect of intraoperative cell salvage and autologous blood transfusion during cesarean section with central placenta previa. Methods From April 2015 to March 2016, 25 pregnants with central placenta previa diagnosed by MRI and ultrasound and underwent selected caesarean section in the People′s Hospital of Wenzhou were included. When the amount of blood in the recovery tank was 450 mL or the obstetrician required, the wash and retransfusion device was started-up. Hb and Hct were measured before and after the parturient, and the blood was recovered. The blood loss, recovery of blood, blood transfusion, allogeneic RBC infusion and the side effects after transfusion and 42 d of postpartum were recorded. Results No serious complications were recorded in all pregnants. Five cases(20%) were only recovered and the autologous blood transfusion and transfusion of the allogeneic RBC were not carried out. In 14 cases(56%), only the autologous blood was returned to the puerpera. The volume of blood transfusion was 705 mL(430, 1 535). Six cases(24%) had massive bleeding during the operation, 3690 mL(1 900, 8 750), and the autologous blood transfusion volume was 2939 mL(1 167, 4 206), and the allogeneic RBC transfusion was 3.5U(1.5, 11.5). Conclusion Autologous blood transfusion can be used safely in the caesarean section of the central placenta previa, and can reduce the allogeneic RBC transfusion. Key words: Placenta previa; Cesarean section; Operative blood salvage; Erythrocytes; Hemoglobins; Hematocrit

Gasless laparoendoscopic single-site surgery with intraoperative autologous blood transfusion for management of ectopic pregnancy with significant hemoperitoneum: a retrospective observational study

BackgroundWith advances in diagnostic and therapeutic modalities, earlier detection of ectopic pregnancy with minimal symptoms makes laparoscopic management more common. However, if diagnostic delay occurs, significant hemoperitoneum associated with ectopic pregnancy is still a potentially life-threatening condition, which presents a therapeutic challenge especially when minimally invasive surgical approach is a significant concern. Herein, retrospective observational study in 18 consecutive cases of ectopic pregnancy with significant hemoperitoneum ≥ 800 mL was performed to assess the feasibility and efficacy of gasless laparoendoscopic single-site (LESS) surgery with intraoperative autologous blood cell salvage and donation for management.ResultsAt triage, median shock index was 0.95, median hemoglobin value was 6.5 g/dL, and median serum β-hCG value was 13,651 U/L. Surgical diagnosis included 7 ampullary (including 5 abortions and 2 ruptures), 5 ruptured isthmic (including 1 heterotopic pregnancy in remnant tube after salpingectomy and 1 remnant tube pregnancy after salpingo-oophorectomy), 4 ruptured interstitial (including 1 case after salpingectomy), and 2 ruptured ovarian pregnancies. Among these cases, 16 cases were successfully managed by LESS surgery, while, in 2 cases with interstitial pregnancy, conversion to multi-port laparoscopic surgery along with transfusion of bank blood were required. Laparotomic conversion was not experienced. Surgical procedures in 16 cases successfully completed by LESS surgery with intraoperative autologous blood transfusion included unilateral salpingectomy for 7 ampullary and 5 isthmic pregnancies, cornuotomy and cornual resection for each 1 case with interstitial pregnancy, and unilateral salpingo-oophorectomy and partial ovarian resection for each 1 case with ovarian pregnancy. Median surgical duration was 57.5 min, median amounts of salvaged peritoneal blood were 950 mL (range 800–2000 mL), and median amounts of transfused autologous blood were 540 mL (range 450–1300 mL). Major complications associated with LESS surgery and intraoperative autologous blood transfusion were not experienced.ConclusionGasless LESS surgery with intraoperative autologous blood transfusion is a feasible minimally invasive surgical option with avoidance to use homologous blood for management of selected cases of ectopic pregnancy even with significant hemoperitoneum.

Clinical Experience of Autologous Blood Transfusion in Neurosurgery: Prospective Study in Central India

To evaluate the benefits of intraoperative autologous blood transfusion in intracranial procedures and to conserve precious homologous blood due to shortage of donor and associated complications. This was a prospective study performed at Bansal Hospital, Bhopal. Predetermined autologous blood was collected in a well-labeled bag containing citrate phosphate dextrose adenine solution after induction of general anesthesia. Then appropriate amount of crystalloid solution was transfused in to the body. All collected autologous blood was transfused back to the patient at the end of the surgery or during the surgery if excessive blood loss occurred. Demographic data, hemodynamic changes (mean arterial pressure, heart rate) before and after donation, complications, and any additional homologous blood requirement were noted. Pre- and postoperative hemoglobin and hematocrit values were compared. In total, 32 patients were included in this study. In our study, mean age was 48.87 years; male-to-female ratio was 1:1.4. The mean amount of autologous blood collected was 461 mL, and the mean amount of blood loss during surgery was 1048 mL. In our study, there was no statistically significant difference was found in mean arterial pressure and heart rate before and after autologous blood collection (P > 0.05). When we compared pre- and postoperative mean hemoglobin and hematocrit levels, there was a statistically significant difference present (P<0.05); this was due to the fact that many patients had meningiomas (15 of 32). Additional homologous blood was required only in 25% of cases (8/32). Of 8 patients, 5 were again cases of deep-seated meningiomas. No complications were observed during or after autologous blood collection. Autologous blood transfusion is a safe, effective, and affordable method of blood transfusion in patients undergoing intracranial surgery. Complications associated with homologous blood transfusion can be avoided with autologous blood transfusion.

Usefulness of Intraoperative Autologous Blood Transfusion in Total Hip Arthroplasty

Usefulness of Intraoperative Autologous Blood Transfusion in Total Hip Arthroplasty

Autotransfusion - The effects of cell salvage on the filterability of autotransfused red cells

30 patients undergoing elective aortic surgery had intraoperative autologous blood transfusion, 15 with the Solcotrans device and 15 with the Haemonetics Cell Saver system. Markers of red cell damage and alteration of red cell parameters and biochemistry were studied. Using the St. Georges Filtrometer, the filterability of preoperative red cells was compared to that of red cells that had undergone salvage

Clinical analysis of thoracoscopic surgery combined with intraoperative autologous blood transfusion in the treatment of traumatic hemothorax

From January 2013 to January 2015, 19 patients of traumatic hemothorax with hemorrhagic shock were treated in our department by thoracoscopic surgery combined with autologous blood transfusion. This study retrospectively analyzed the therapeutic effect and shared our experience. The average amount of blood transfused back was 662.41 ml ± 269.15 ml. None of the patients developed transfusion reaction and were all discharged uneventfully. Thoracoscopic surgery combined with autologous blood transfusion is effective in the rescue of patients with progressive hemothorax and hemorrhagic shock. When corresponding indications are well managed, treatment for these patients is quicker, safer, and more effective.

Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.

Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P<0.001],platelets [(275.0±71.3)×10(9)/L vs. (237.7±68.0)×10(9)/L,P=0.048] and neutrophils [(4.7±1.7)×10(9)/L vs. (3.9±1.4)×10(9)/L,P=0.044] and higher incidence of pulmonary function abnormality (42.9% vs.16.7%,P=0.024).More AS patients were induced with scoline (14.3% vs.0,P=0.012). More AS patients underwent THA with Mallampati classification 3 (28.6% vs.7.1%,P=0.022),reduced neck extension(47.6% vs.2.4%,P<0.001),Cormack-Lehane classification2(56.3% vs.15.4%,P=0.002)and 3 (18.8% vs.0,P=0.005),while much fewer AS patients had Cormack-Lehane classification1 (25.0% vs.84.6%,P<0.001).A variety of difficult airway tools were used in intubation (AS group:Macintosh laryngoscope:14%,Macintosh laryngoscope with stylet:38%,visualization laryngoscope:24%,visualization stylet:10% and fiber bronchoscope:14%;non-AS group:57%,24%,12%,5% and 2%,respectively). The use of intraoperative autologous blood transfusion (33.3% vs.11.9%,P=0.041) and postoperative 24 h drainage (61.9% vs.31.0%,P=0.019) were more common in AS group. However,no statistical difference existed in the success rate of first intubation,postoperative hemoglobin,postoperative hematocrit,and postoperative hospitalization(all P>0.05). Conclusions AS patients undergoing THA have elevated preoperative inflammatory markers,with high incidence of pulmonary function abnormality and difficult airway. In consideration of high risk of surgery and anesthesia,adequate airway evaluation and optimization of perioperative management are needed to ensure the patients' safety.

Synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma associated with cirrhotic portal hypertensive hypersplenism

Objective To investigate the safety and clinical efficacies of synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma (HCC) associated with cirrhotic portal hypertensive hypersplenism. Methods The clinical data of 5 patients with HCC associated with cirrhotic portal hypertensive hypersplenism who were admitted to the Clinical Medical College of Yangzhou University between January 2015 and April 2015 were retrospectively analyzed. Five patients underwent synchronous laparoscopic hepatectomy combined with splenectomy and intraoperative autologous blood transfusion. The operation time, volume of intraoperative blood loss, time for diet intake, postoperative drainage tube removal time, duration of hospital stay and occurrence of complications were observed. Patients were followed up by outpatient examination and telephone interview till June 2015. Measurement data with normal distribution were presented as ±s. Results Of the 5 patients without conversion to open surgery, 3 patients underwent synchronous laparoscopic hepatectomy combined with splenectomy, 1 patient underwent laparoscopic hepatectomy+ splenectomy+ cholecystectomy and 1 patient underwent laparoscopic hepatectomy+ splenectomy+ devascularization. The operation time and volume of blood loss were (225±41)minutes and (221±81)mL. All the patients received intraoperative autologous blood transfusion without homologous blood transfusion. Two patients were complicated with abdominal effusion including 1 patient associated with pleural effusion, and symptoms of 2 patients disappeared after conservative treatment. All the patients took fluid diet at postoperative day 1 and out-of-bed activity at postoperative day 2, and drainage tubes were removed at postoperative day 3, with good recovery and without perioperative death. The duration of postoperative hospital stay was (7.8±0.8)days. All the 5 patients were followed up and survived well up to the end of follow-up. Conclusion Synchronous laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of HCC associated with cirrhotic portal hypertensive hypersplenism with an exact curative effect. Key words: Liver neoplasms; Hypersplenism; Splenectomy; Hepatectomy; Laparoscopy

Intraoperative blood loss, postoperative drainage, and recovery in patients undergoing lumbar spinal surgery

BackgroundSpine surgery is widely accepted as an effective management for patients with lumbar disc herniation; however, the factors influencing intraoperative procedure and prognosis are not fully understood. The present study was aimed to identify the factors influencing intraoperative blood loss, postoperative drainage volume, and recovery in patients undergoing spinal surgery.MethodsWe retrospectively analyzed the clinical data of 183 consecutive patients with lumbar disc herniation who underwent spine surgery. The clinical characteristics, operation procedure, and outcome were documented and the correlations were analyzed.ResultsThere were significant differences between one-level and two-level operations in the bleeding volumes of male (P = 0.005) and female (P = 0.002) patients, and in final drainage of male (P = 0.043) and female (P = 0.003) patients. The blood loss was correlated with the operation duration. There were differences in intraoperative bleeding and final drainage between groups with one-level and two-level operations. Additionally, there were differences in intraoperative autologous blood transfusion among various groups. There were significant differences in intraoperative bleeding between autologous blood transfusion and non-transfusion groups.ConclusionsThe key factors affecting the intraoperative blood loss and postoperative drainage volume include operation methods, operation duration, blood-transfusion modes, and usage of anticoagulants. These results should be taken into consideration in the attempt to optimize operation procedure and improve post-operative recovery.

Single-incision laparoscopic splenectomy for massive splenomegaly combining gastroesophageal devascularization using conventional instruments.

Single-incision laparoscopic splenectomy has been reported and was proved to be feasible and safe. Yet reports on single-incision laparoscopic surgery (SILS) for massive splenomegaly is not seen, neither is SILS for gastroesophageal devascularization; another correlated procedure for patients complicated with bleeding esophageal varices. From February 2011 to March 2012, 6 male patients with a median age of 45.1 years (range, 25 to 65 y) who were diagnosed of liver cirrhosis, portal hypertension, splenomegaly, and hypersplenism underwent SILS by the same surgical team in our hospital. Of them, 4 patients who were indicated had combined gastroesophageal devascularization, except for 1 conversion to hand-assisted laparoscopic approach because of bleeding, the operations were performed uneventfully and the surgical outcomes were satisfactory. Preoperative diagnosis was hypersplenism secondary to liver cirrhosis, the surgical outcome was satisfactory. This video, Supplemental Digital Content 1 and 2, http://links.lww.com/SLE/A104 and http://links.lww.com/SLE/A105 illustrates the crucial steps regarding the SILS for massive splenomegaly combined with gastroesophageal devascularization. The preoperative diagnosis are, hepatitis B, the patient's liver function is Liver Child-Pugh grade A. The patient was placed in reverse Trendelenburg position, with the legs open. The surgeon was standing on the right side of the patient and an assistant standing in between the legs. One 20-mm incision was made under the umbilicus, a 10-mm Trocar (Johnson & Johnson Investment Co. Ltd., NJ) was introduced in the middle of the incision, and the abdominal cavity was explored with a 10-mm, 30-degree scope (Storz Co. Ltd., Germany). Then a 12-mm and a 5-mm trocar were introduced through the same incision, respectively, 45 degree to the 10-mm trocar at both sides to form a "∇" shape. The procedure started with the dissection of the splenocolic ligament at the lower pole of the spleen, followed by creating a window by dissecting the gastrocolic ligament. The secondary branches of splenic pedicle were dissected and divided. The dissection of splenogastric ligament was continued along the gastric greater curvature, and short gastric vessels were encountered and divided. The left gastric artery was clipped and secured, followed by gastroesophageal devascularization along the cardiac to the esophagus 5 cm away from the esophagocardia junction, with Ligasure device. The splenic artery was identified, clipped, and divided. The splenic vein was finally divided followed by intraoperative autologous blood transfusion technique by collecting the blood from the distal splenic vein. The spleen was removed from the umbilical incision in a sample bag after being sliced into pieces. A drainage was placed through the incision. The operation was successful and the patient recovered well postoperatively: the operation time was 265 minutes, and the intraoperative blood loss was 300 mL. The postoperative course was uneventful and the patient was discharged 13 days later. SILS combining gastroesophageal devascularization for massive splenomegaly is technically feasible in the hands of surgeons with experiences of laparoscopic splenectomy. Indeed, the relative large scale of operation field for laparoscopic splenectomy makes the conflicts of instruments less practically challenging; however, techniques and sequences of the laparoscopic procedures should be modified to facilitate it, given the unavoidable constriction of movements for each instrument.

Intraoperative autologous blood transfusion of peritoneal blood during laparotomy for ectopic pregnancy: prospective study.

The purpose of this study was to evaluate the efficacy and safety of intraoperative autologous blood transfusion during laparotomy for hemoperitoneum in ectopic pregnancy and also safety of homologous blood transfusion along with autologous blood transfusion. Fresh blood, from peritoneal cavity, was collected for autotransfusion in sterile dish, filtered through eight layers of sterile gauze pieces, and collected in a sterile bowl. The collected blood was transferred into blood infusion bag containing citrate phosphate dextrose adenine solution in the proportion of five parts of blood to one part of citrate solution. Mean volume of autologous blood transfused in patients without homologous transfusion was 573±328. Mean preoperative hemoglobin was 4.95±1.5, and postoperative hemoglobin was 6.85±1.3. Hence, rise in hemoglobin was 1.9 g%. Autologous blood volume transfused in 29 patients (who required homologous blood transfusion) was 488±216. Preoperative hemoglobin was 4.35±1.94. The result was compared with other studies. Intraoperative autologous blood transfusion enabled the performance of laparotomy in hemodynamically unstable ectopic pregnancy patients without availability of homologous blood transfusion. Homologous blood transfusion is compatible with autologous blood transfusion.

Morbidity and mortality after autotransfusion following open heart surgery

BackgroundThe technique of ‘blood pooling’ before the onset of cardiopulmonary bypass (CPB) has been shown to be beneficial as a single technique in patients having elective open heart surgery. We sought to more clearly evaluate the role of intra-operative autologous donation also known as acute normovolemic haemodilution in open heart surgery.MethodsThe study was conducted in the Department of Cardiothoracic and Vascular Surgery, King George’s Medical University, Lucknow, India, in patients who underwent open heart surgery under cardiopulmonary bypass. Autologous blood transfusion was used in all the patients who underwent surgery on CPB since August 2009. Patients were divided into two groups: group I (study group)—patients operated between August 2009 and December 2011 and who received autologous blood and group II (control)—those operated before August 2009 and who did not receive autologous blood transfusion.ResultsThe post-operative haemoglobin and coagulation profile measured on the first post-operative day differed significantly between the two groups. Intensive care unit (ICU) stay, hospital stay, inotropic support and ventilatory support were significantly less in group 1. Mediastinal drainage was found to be significantly higher in the control group compared to the study group. The mean volume of packed red blood cell, fresh frozen plasma and platelet units transfused per patient in the study group were significantly less than the control group.ConclusionThe use of intra-operative autologous blood donation and transfusion improves haemostasis, decreases the post-operative blood loss and improves the post-operative outcome in terms of intensive care unit stay, hospital stay, morbidity and mortality.

Clinical study of free auxiliary device of hand assisted laparoscopic splenectomy and intraoperative autologous splenic blood transfusion

Objective To investigate the feasibility and advantage of hand assisted laparoscopic splenectomy for giant spleens without auxiliary device and the clinical value of intraoperative autologous splenic blood transfusion.Methods From October 2007 to October 2011,48 cases of liver cirrhosis splenomegaly were analyzed retrospectively according to operation method including hand assisted laparoscopic splenectomy group with free auxiliary device (HALS) (n =30) and conventional laparoscopic splenectomy (CLS) (n =12),and they were divided into two groups:severe splenomegaly group (the length of the spleen more than 20 cm) and moderate splenomegaly (the length of the spleen less than 20 cm).The intraoperative bleeding,operation time,the spleen removal time and transit operation rate were compared in these patients.The blood transfusion machine was used for autologous splenic blood transfusion.Results Free auxiliary device saved at least 2000 yuan without affecting the maintenance of pneumoperitoneum during operation.There was no significant difference in the average blood loss between HALS group and CLS group [(88.1 ± 16.3) ml vs.(107.5 ± 11.6) ml,P ＞0.05].The average operation time was significantly shorter [(75.2 ± 13.3) min vs.(120.7 ± 20.5) min,P ＜ 0.05],and the spleen removal time was markedly shorter [(8.0 ±3.1) min vs.(25.2 ±2.8) min,P ＜0.05] in HALS group than in CLS group.The transit operation rate of severe splenomegaly (50％) was significantly higher than moderate splenomegaly (20％) (P ＜ 0.01),and the intraoperative bleeding too [(103.8 ± 25.0) ml vs.(70.4 ± 10.3) ml,P ＜0.01].Intraoperative autologous splenic blood transfusion significantly elevatedf hemoglobin level on the first day after operation [(2.07 ± 0.25) g/L,P ＜ 0.05].Conclusion HALS significantly facilitates the surgical procedure and reduces the operational risk,while maintaining the advantages of CLS.Hand-assisted laparoscopic splenectomy is a safe and effective technique especially for the management of severe splenomegaly.Intraoperative autologous splenic blood transfusion shows obvious special advantage in ascending hemoglobin. Key words: Hand-assisted laparoscopic splenectomy; Splenomegaly; Splenic blood transfusion

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.