Intraoperative Blood Cell Salvage Research Articles

Ruptura pankreasne pseudoaneurizme kao posledice hroničnog pankreatitisa - prikaz slučaja

Abstract: Introduction: Pseudoaneurysms of the pancreaticoduodenal arcade are rare, accounting for approximately 2% of all visceral artery aneurysms. They typically arise as complications of chronic pancreatitis, peptic ulcer disease, trauma, pancreatic and biliary surgery, or pancreas transplantation. Diagnosis often occurs only after rupture, leading to life-threatening internal bleeding. Bleeding may occur within a pseudocyst, with blood passing through the Vater's papilla into the digestive tract, or may result in the formation of a retroperitoneal hematoma that can rupture into the abdominal cavity, causing hemoperitoneum. The cell-saver is a tool that can be utilized for intraoperative blood cell salvage and autologous transfusions. Case Report: Our patient, a 54-year-old male, an untreated alcoholic with no prior medical history or documented treatment, presented to the Clinic for Emergency Surgery at the University Clinical Center of Serbia with a sudden onset of upper abdominal pain. A quick ultrasound of the abdomen was performed, followed by an urgent CT scan of the chest and abdomen, revealing a hematoma extending from the right retroperitoneum and mesentery of the intestine, measuring 150x109x180mm in diameter, with signs of active bleeding in the region beneath the pancreas, indicative of hemoperitoneum. Due to hemodynamic instability, accompanied by a drop in arterial blood pressure and hemoglobin levels, an urgent laparotomy was performed. Active bleeding was identified from a ruptured pseudoaneurysm originating from the pancreaticoduodenal arcade. Hemostasis was achieved followed by tamponade, and the tampons were removed 30 hours post-surgery. The patient remained hemodynamically stable thereafter, recovered well from the surgery, and was discharged home in good general condition. Intraoperatively, we utilized the Cell-saver to collect the patient's blood and subsequently administered autologous transfusion. Conclusion: In patients with chronic pancreatitis presenting with sudden abdominal pain and hemodynamic instability accompanied by a drop in arterial pressure, hemoglobin, and hematocrit levels, the possibility of a ruptured pseudoaneurysm in the pancreatic or peripancreatic region should be considered. Timely diagnosis and prompt surgical intervention are crucial for a successful outcome. Effective collaboration among radiologists, anesthesiologists, and surgeons is essential. The utilization of the Cell-saver system significantly aids in maintaining cardiac output and hemodynamic stability in these patients.

Evaluation of the Feasibility of Transfusing Leukocyte Depletion Filter–Processed Intraoperative Cell Salvage Blood in Metastatic Spine Tumor Surgery: Protocol for a Non Randomized Study (Preprint)

Evaluation of the Feasibility of Transfusing Leukocyte Depletion Filter–Processed Intraoperative Cell Salvage Blood in Metastatic Spine Tumor Surgery: Protocol for a Non Randomized Study (Preprint)

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study.

This study was designed to explore factors associated with the incidence of positive bacterial culture of salvaged red blood cells (sRBCs) recovered with a Cell Saver instrument during cardiac surgery and the impact of such positive outcomes on postoperative infection-related morbidity. The cohort study enrolled 204 patients scheduled for cardiac surgery with intraoperative blood cell salvage and retransfusion from July 2021 to July 2022. These patients were stratified into two groups based on intraoperative sRBCs bacterial culture results: culture (+) and culture (-) groups. Preoperative and intraoperative variables were compared between these groups aim to detect possible predictors of positive culture in sRBCs. In addition, differences in postoperative infection-related morbidity and other clinical outcomes were compared between these groups. Of these patients, 49% were sRBCs culture (+), with Staphylococcus epidermidis as the most commonly identified pathogen. Risk factors independently associated with the risk of positive culture in sRBCs included BMI ≥25 kg/m2, a history of smoking, an operative duration ≥277.5 min, the higher number of staff in the operating room and higher surgical case order. Patients in the sRBCs culture (+) group exhibited a longer average ICU stay [3.5 days (2.0-6.0) vs. 2 days (1.0-4.0), P < 0.01], a longer duration of ventilation [20.45 h (12.0-17.8) vs. 13 h (11.0-17.0, P = 0.02)], underwent more allogeneic blood transfusions, exhibited higher transfusion-related costs [2,962 (1,683.0-5,608.8) vs. 2,525 (1,532.3-3,595.0), P = 0.01], and had higher rates of postoperative infections (22 vs. 9.6%, P = 0.02) as compared to patients in the sRBCs culture (-) group. In addition, culture (+) in sRBCs was an independent risk factor for postoperative infection (OR 2.62, 95% CI 1.16-5.90, P = 0.02). Staphylococcus epidermidis was the most common pathogen detected in sRBCs in the culture (+) group in this study, identifying it as a potential driver of postoperative infection. Positive sRBCs culture may contribute to postoperative infection and its incidence was significantly associated with patient BMI, history of smoking, operative duration, the number of staff in the operating room and surgical case order.

Should Cell Salvage Be Used in Liver Resection and Transplantation? A Systematic Review and Meta-analysis.

To evaluate the effect of intraoperative blood cell salvage and autotransfusion (IBSA) use on red blood cell (RBC) transfusion and postoperative outcomes in liver surgery. Intraoperative RBC transfusions are common in liver surgery and associated with increased morbidity. IBSA can be utilized to minimize allogeneic transfusion. A theoretical risk of cancer dissemination has limited IBSA adoption in oncologic surgery. Electronic databases were searched from inception until May 2021. All studies comparing IBSA use with control in liver surgery were included. Screening, data extraction, and risk of bias assessment were conducted independently, in duplicate. The primary outcome was intraoperative allogeneic RBC transfusion (proportion of patients and volume of blood transfused). Core secondary outcomes included: overall survival and disease-free survival, transfusion-related complications, length of hospital stay, and hospitalization costs. Data from transplant and resection studies were analyzed separately. Random effects models were used for meta-analysis. Twenty-one observational studies were included (16 transplant, 5 resection, n=3433 patients). Seventeen studies incorporated oncologic indications. In transplant, IBSA was associated with decreased allogeneic RBC transfusion [mean difference -1.81, 95% confidence interval (-3.22, -0.40), P =0.01, I 2 =86%, very-low certainty]. Few resection studies reported on transfusion for meta-analysis. No significant difference existed in overall survival or disease-free survival in liver transplant [hazard ratio (HR)=1.12 (0.75, 1.68), P =0.59, I 2 =0%; HR=0.93 (0.57, 1.48), P =0.75, I 2 =0%] and liver resection [HR=0.69 (0.45, 1.05), P =0.08, I 2 =0%; HR=0.93 (0.59, 1.45), P =0.74, I 2 =0%]. IBSA may reduce intraoperative allogeneic RBC transfusion without compromising oncologic outcomes. The current evidence base is limited in size and quality, and high-quality randomized controlled trials are needed.

Blood Cell Salvage and Autotransfusion Does Not Worsen Oncologic Outcomes Following Liver Transplantation with Incidental Hepatocellular Carcinoma: A Propensity Score-Matched Analysis

Intraoperative blood cell salvage and autotransfusion (IBSA) during liver transplantation (LT) for hepatocellular carcinoma (HCC) is controversial for concern regarding adversely impacting oncologic outcomes. We aimed to evaluate the long-term oncologic outcomes of patients who underwent LT with incidentally discovered HCC who received IBSA compared with those who did not receive IBSA. Patients undergoing LT (January 2001-October 2018) with incidental HCC on explant pathology were retrospectively identified. A 1:1 propensity score matching (PSM) was performed. HCC recurrence and patient survival were compared. Kaplan-Meier survival analyses were performed, and univariable Cox proportional hazard analyses were performed for risks of recurrence and death. Overall, 110 patients were identified (IBSA, n=76 [69.1%]; non-IBSA, n=34 [30.9%]). Before matching, the groups were similar in terms of demographics, transplant, and tumor characteristics. Overall survival was similar for IBSA and non-IBSA at 1, 3, and 5years (96.0%, 88.4%, 83.0% vs. 97.1%, 91.1%, 87.8%, respectively; p=0.79). Similarly, the recurrence rate at 1, 3, and 5years was not statistically different (IBSA 0%, 1.8%, 1.8% vs. non-IBSA 0%, 3.2%, 3.2%, respectively; p=0.55). After 1:1 matching (26 IBSA, 26 non-IBSA), Cox proportional hazard analysis demonstrated similar risk of death and recurrence between the groups (IBSA hazard ratio [HR] of death 1.26, 95% confidence interval [CI] 0.52-3.05, p=0.61; and HR of recurrence 2.64, 95% CI 0.28-25.30, p=0.40). IBSA does not appear to adversely impact oncologic outcomes in patients undergoing LT with incidental HCC. This evidence further supports the need for randomized trials evaluating the impact of IBSA use in LT for HCC.

The Association of Targeted Cell Salvage Blood Transfusion During Cesarean Delivery With Allogeneic Packed Red Blood Cell Transfusions in a Maternity Hospital in China.

Autologous transfusion of intraoperative cell salvage blood may be a potential method to decrease the need for allogeneic packed red blood cell transfusions after cesarean delivery, although there are limited data on the benefits of this method. This study evaluated the implementation of targeted intraoperative cell salvage during cesarean delivery in women at increased risk for hemorrhage at the Women's and Children's Hospital in Ningbo, China. All women who underwent cesarean delivery >28 weeks of gestation were included in the study. The period before intraoperative cell collection (October 1, 2010, to August 31, 2012, n = 11,322) was compared with the postimplementation period (September 1, 2012, to June 30, 2015, n = 17,456) using an interrupted time series analysis. In the postimplementation period, women suspected to be at increased risk of the need for a blood transfusion (1604, 9.2%) underwent intraoperative cell salvage collection. The primary outcomes were the monthly rate of allogeneic packed red blood cell use and the incidence of clinical manifestation of acute blood transfusion reactions. The mean (standard deviation) estimated monthly allogeneic packed blood cell transfusion rate at the end of the 57-month study was 2.2% ± 0.7% with the implementation compared with 2.7% ± 0.9% without, difference -0.5%, 95% CI, -1.4% to 0.3%; P = .22. The mean number of allogeneic units transfused per patient was 4.1 ± 0.4 units with implementation and 3.9 ± 0.9 units without, difference 0.2, 95% CI, -1.7 to 1.1 units; P = .69. Intraoperative cell salvage blood was reinfused in 757 (47%) and wasted in 847 (53%) cases. The monthly intraoperative allogeneic packed red blood cells use rate was lower after implementation (difference -0.7%, 95% CI, -0.1% to -1.4%; P = .03); however, the monthly postpartum allogeneic packed red blood cell use rate was unchanged (difference -0.2%, 95% CI, -0.4% to 0.7%; P = .56). The clinical manifestation of acute blood transfusion reactions rate was unchanged (difference -2%, 99% CI, -9% to 5%; P = .55) between the periods. Our findings suggest that targeted intraoperative cell salvage in women undergoing cesarean delivery was associated with less allogeneic blood exposure in the operating room, but not in the postoperative period. Intraoperative cell salvage in targeted cesarean deliveries was not associated with a lesser allogeneic red blood cell exposure over the hospital admission period. The lack of adverse events associated with intraoperative cell salvage supports the safety of intraoperative cell salvage in cesarean delivery.

Safety of leucodepleted salvaged blood in oncological surgery: an in vitro model.

Intra-operative blood cell salvage (IOCS) is mainly avoided in onco surgery due to the suspicion that it could increase metastasis' risk. We simulated IOCS followed by leucodepletion: HCT116 (human colorectal cancer) cells were inoculated into packed red blood cells units, and their distribution was evaluated, step-by-step, by flow cytometry and immunohistochemistry. Most of HCT116 cells were lost during washing, and almost completely removed after filtration. IOCS plus leucodepletion could be of great advantage for oncological patients, where allogenic blood transfusion could influence tumour progression.

A Single-Center Experience of Transfusion Free Surgical Treatment over 13 Years in Korea

Objective: Patient’ desire of transfusion free surgery has been increasing due to blood transfusion risks. We analyzed the perioperative parameters and perioperative management of transfusion free surgical treatment in Soonchunhyang University Seoul Hospital. Methods: Operation quantity and blood unstoring count from blood bank between 2000 and 2012 were collected from chronological records. Perioperative parameters including preoperative hemoglobin level, postoperative hemoglobin level, and lowest hemoglobin level were collected from medical records. Perioperative blood management such as acute normovolemic hemodilution, intraoperative blood cell salvage, or hematinic agents and complication were assessed. Results: A total of 3,088 patients underwent transfusion free surgery at Soonchunhyang University Seoul Hospital between 2000 and 2012. Postoperative hemoglobin level < 5.0 g/dL were 33 patients. Four patients expired at postoperative period with serious perioperative complications. Average of expired patient’s hemoglobin was 3.22 g/dL and overall mortality was 0.12%. Operation was increased as years go by. The amount of blood use bank wasn’t increased in general patients with transfusion. Conclusion: Careful perioperative blood management for transfusion free surgical treatment was responsible for safety and results in good clinical outcomes. Overall transfusion rate was decreased in spite of increasing operation quantity.

The Use of Blood Cell Salvage in Acetabular Fracture Internal Fixation Surgery

To determine if the routine use of intraoperative blood cell salvage in acetabular fracture internal fixation reduces the need for allogenic blood transfusion, is cost effective, and whether it is influenced by the acetabular fracture pattern. A retrospective study. Tertiary pelvic and acetabular reconstructive center. Patients undergoing internal fixation for acetabular fractures. Eighty consecutive patients were reviewed, comprising 26 elementary fracture (EF) and 54 associated fracture (AF) types. The mean volume of autologous blood transfused was 484 mL. The mean volume of 561 mL of autologous blood transfused in patients with AF types was significantly greater than the mean volume of 325 mL transfused in the EF group (P = 0.007). Additional allogenic blood transfusion was required in 5 (19%) patients with EFs and 15 (28%) patients with AFs (P = 0.418). The mean cost of the blood cell salvage and additional blood products in our study was $223 (£135) for all fracture types ($174/£105 for EF and $246/£149 for AF).When treating AF types, the mean cost of using blood cell salvage was $246 (£149) as compared with the mean predicted cost of not using blood cell salvage and transfusing the equivalent of 1.7 units of allogenic blood instead, which was $463 (£281). These distributions are significantly different (P = 0.01). The use of blood cell salvage for internal fixation surgery for acetabular fracture is cost effective, particularly when treating AF types, and its routine use is advocated to limit the need for allogenic blood transfusion.

A review of obstetric intraoperative blood cell salvage in a tertiary maternity unit

BackgroundIntraoperative Cell Salvage (ICS) is a well-established technique for replacing blood in other surgical specialities, but its introduction into obstetrics has been slower due to theoretical safety concerns about amniotic...

Oncologic outcomes following radical prostatectomy with intraoperative cell salvage

To evaluate oncologic outcomes following the use of intraoperative cell salvage (IOCS) as a blood loss management strategy during open radical prostatectomy (RP). We retrospectively reviewed all open retropubic RP cases performed by a single surgeon. Patients were identified who received IOCS blood and evaluated for an increased risk of biochemical recurrence (BCR) and overall mortality. The study cohort consisted of 1,862 men, 395 (21.2%) of whom received IOCS blood. At a median follow-up of 47.0months, men who received IOCS blood were not at an increased risk of BCR (P=0.323) or all-cause mortality (P=0.892). IOCS use did not confer an increased risk of BCR within any D'Amico preoperative risk category (low risk, P=0.592; intermediate risk, P=0.107; and high risk, P=0.697). IOCS is safe for the management of blood loss during RP. At long-term follow-up, IOCS use was not associated with an increased risk of BCR or death. While it remains preferable to avoid any form of blood transfusion, we advocate for the use of IOCS in place of allogeneic blood. These conclusions are drawn from our study of the largest and longest followed cohort patients who received IOCS blood during RP.

A Case of Glomus Vagale Tumor with the Complaint of Hoarseness

Dear Editor, Vagal paragangliomas are uncommon tumors of the parapharyngeal space, approximately 200 cases having been reported.[1] They arise from tissue of the extra adrenal sympathetic nervous system.[2] They mostly manifest as a painless neck mass near the angle of the mandible usually between the skull base and the hyoid bone.[3] The other manifestations are hoarseness and less commonly dysphagia, palatal weakness and tongue hemi-atrophy.[1][4] Pressure on the cervical sympathetic chain causes horner syndrome. Ultrasonography, CT scan, MRI and angiography are diagnostic modalities been used, but combining conventional MR imaging with CE-MRA has dramatic diagnostic value for the assessment of head and neck paragangliomas.[5] Surgical resection is the treatment for carotid body tumors, and the procedure should be undertaken unless the patient has a prohibitive operative risk.[4] Here we present a rare glomus vagale case presented with hoarseness and show his management. A 37 years old farmer presented with hoarseness and left cervical mass beyond mandible angle. He did not claim of another symptom, on physical examination a firm mobile 2x2 cm mass was moving horizontally. Before treatment planning, we found left vocal cords paralyzed and CT scan demonstrated a heterogenous lesion next to the carotid bifurcation (Figure 1). Planning resection, he underwent surgery and we found two masses, one in 1.5x1.5 over bifurcation and the other just in bifurcation area extending toward skull through vagal foramen, we could resect these highly vascular masses while saving carotid branches but sacrificing involved vagal nerve. Pathologist confirmed these paragangliomas. Fig. 1 CT scan shows left neck mass. The normal carotid body is a small mass of neurovascular tissue located bilaterally in the medial valley of the carotid artery bifurcation. Although the term has historically been assigned to these masses, they are not carcinomas, and the neoplastic process is actually hypertrophy of the carotid body tissue.[6] The four main locations of glomus tissue within the head and neck are: (a) The carotid bifurcation (carotid body tumor), (b) The inferior ganglion region (ganglion nodosum) and cervical portion of the vagus nerve (glomus vagale or vagal paraganglioma), (c) The jugular bulb region (glomus jugulare) and (d) The middle ear cavity (glomus tympanicum).[3] Paragangliomas originate in the head and neck from the brachiomeric family of paraganglia, neuroendocrine tissue which lies along the carotid artery, the aorta, the glossopharyngeal nerve, and the middle ear.[7] Preoperative planning requires a selective carotid arteriogram to clarify arterial anatomy and the relation of the carotid body tumor to the carotid bifurcation. Embolization of the tumor may also be achieved through these branch vessels, particularly in cases in which the lesion extends over a considerable distance and may approach the base of the skull. Challenging options about surgical versus radiation treatment continues, advocating radiation for small lesions,[8][9] and surgery in younger patients and tumors causing bony destruction.[10] Morbidity associated with vagal paraganglioma surgery is significantly higher than that of carotid body tumor surgery. Plans for intraoperative blood cell salvage are appropriate, as significant blood loss is routine in the dissection of these lesions.[6] Therapeutic embolization reduces the size of the tumor and limits intraoperative blood loss but may rarely be considered as definitive treatment.[11] Radiation therapy is an alternative to surgery and may be effective in arresting the growth, but it can lead to neurologic sequelae and rarely can destroy the tumor. Irradiation is generally used in elderly patients as well as in large and unresectable tumors [1] and gathering data upon clinical examination and imaging, we prepared our client to surgery. Under general anesthesia via standard cervical approach, tumor dissected off the carotid branches but found left vagus nerve involved, extending toward skull base through cranial nerve foramen, so had to sacrify it.

Severe hypotension related to cell salvaged blood transfusion in obstetrics

Intra-operative blood cell salvage has recently been adopted for use in women at risk of significant haemorrhage during caesarean section. It has also been advocated for use in those patients who refuse allogenic blood transfusion. A 37-year-old pregnant woman (gravida 3, para 2) underwent an elective lower segment caesarean section at 36 weeks for an anterior, major placenta accreta (grade 4). The volume of cell salvaged blood collected during the procedure was 1870 ml. On starting the cell-salvaged blood transfusion, the blood pressure was noted to fall and this was temporally related to the transfusion of the cell-salvaged blood. We review the recent literature and case reports on hypotension related to cell-salvaged blood transfusion.

Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood

Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood

Influence of intraoperative blood cell salvage on erythrocyte immunity and immunoreceptor expression

Objective To investigate the influence of intraoperative blood cell salvage on erythrocyte immunity and the expression of CD35 and CD58. Methods Sixteen patients undergoing total hip replacement or artificial femoral head arthroplasty were chosen. Blood (5 ml) was collected from operation field and from cell saver, respectively to measure rosette rate of RBC · C3b receptor (RCR) and immune complex rosette rate of red cell (RICR). The expression of CD35 and CD58 on erythrocytes was detected with flow cytometer. Results Both RCR and RICR from cell saver, and the expression of CD35 and CD58 on erythrocytes from cell saver were significantly lower than those from operation field. Conclusion Intraoperative salvage of blood cells inhibits the erythrocyte immunity, which may be related to the inhibition of CD35 and CD58 expression on erythrocytes. Key words: blood salvage; erythrocyte immunity; CD35 ; CD58

Release of inflammatory mediators in irradiated cell salvage blood and their biological consequences in human beings following transfusion

Background and objective: Irradiation of intraoperative cell salvage blood has recently been used to inactivate tumour cells before retransfusion, during cancer surgery. No information is available about a potential inflammatory response of the recipient to the retransfusion of irradiated intraoperative cell salvage blood. This pilot study was conducted to investigate the possible release of the pro-inflammatory mediators, tumour necrosis factor-α (TNF-α), interleukin-1β (IL-1β), eotaxin and monocyte chemo-attractant protein-1 (MCP-1), in the serum of recipients by intraoperative retransfusion of irradiated intraoperative cell salvage blood. Methods: Nine patients undergoing gynaecological cancer surgery were included in this study. Intraoperative cell salvage blood was irradiated with 50 Gy and retransfused to the patient. Serum and intraoperative cell salvage blood concentrations of TNF-α, IL-1β, eotaxin and MCP-1 were repeatedly analysed before and after retransfusion, respectively before and after irradiation. Results: Traces of mediators were detected in intraoperative cell salvage blood but no increase due to irradiation was observed. Following transfusion of intraoperative cell salvage blood, minute quantities (all <30 pg mL−1) of mediators were detected in the serum of patients. However, there was no significant upregulation compared to serum values before retransfusion. Conclusions: These results provide evidence that retransfusion of irradiated intraoperative cell salvage blood might represent a blood-saving strategy in cancer surgery without an immunological inflammatory response as shown by a lack of upregulation of inflammatory mediators.

Release of inflammatory mediators in irradiated cell salvage blood and their biological consequences in human beings following transfusion.

Irradiation of intraoperative cell salvage blood has recently been used to inactivate tumour cells before retransfusion, during cancer surgery. No information is available about a potential inflammatory response of the recipient to the retransfusion of irradiated intraoperative cell salvage blood. This pilot study was conducted to investigate the possible release of the pro-inflammatory mediators, tumour necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), eotaxin and monocyte chemo-attractant protein-1 (MCP-1), in the serum of recipients by intraoperative retransfusion of irradiated intraoperative cell salvage blood. Nine patients undergoing gynaecological cancer surgery were included in this study. Intraoperative cell salvage blood was irradiated with 50 Gy and retransfused to the patient. Serum and intraoperative cell salvage blood concentrations of TNF-alpha, IL-1beta, eotaxin and MCP-1 were repeatedly analysed before and after retransfusion, respectively before and after irradiation. Traces of mediators were detected in intraoperative cell salvage blood but no increase due to irradiation was observed. Following transfusion of intraoperative cell salvage blood, minute quantities (all < 30 pg mL(-1) of mediators were detected in the serum of patients. However, there was no significant upregulation compared to serum values before retransfusion. These results provide evidence that retransfusion of irradiated intraoperative cell salvage blood might represent a blood-saving strategy in cancer surgery without an immunological inflammatory response as shown by a lack of upregulation of inflammatory mediators.

The effect on coagulation parameters of the transfusion of cell saved blood after cardiac surgery

Intraoperative cell salvage (IOCS) minimizes exposure to donor blood. However, the process removes plasma and platelets and may worsen the coagulopathy induced by heparinization and cardiopulmonary bypass (CPB). Accordingly, we undertook a prospective observational study to examine the changes in coagulation parameters following the retransfusion of IOCS blood.