Intraoperative Red Cell Salvage Research Articles

Use of Intraoperative Red Cell Salvage in the Contemporary Management of Placenta Accreta Spectrum Disorders

(Can J Anesth/J Can Anesth. 2023;70:1544–1546) Management of hemorrhage after cesarean delivery or cesarean hysterectomy is complex. Intraoperative red cell salvage (IOCS) is commonly used in other surgical settings and is increasingly used in obstetrics. The potential risks such as amniotic fluid embolism, bacteremia, sepsis, and coagulopathy in obstetrics remain poorly understood. This study assessed the use of IOCS in the management of placenta accreta spectrum (PAS) disorders.

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

OP61 - Metabolic acidosis after heart surgery and intraoperative red cell salvage

OP61 - Metabolic acidosis after heart surgery and intraoperative red cell salvage

Failure of Intraoperative Red Cell Salvage: A Patient with Sickle Cell Disease and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) Syndrome

Cell salvage is a process whereby the bloodshed from the operative field is collected and returned to the patient. It can be especially useful when allogeneic red blood cell (RBC) units are not readily available such as when the recipient has multiple alloantibodies. We report on the anesthesia and transfusion strategies for managing a pregnant patient with sickle cell disease (SCD) with HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome. A pregnant patient with twins at 30 weeks of gestation was admitted in an SCD crisis. She subsequently developed HELLP syndrome and required urgent cesarean delivery; however, she had multiple RBC antibodies complicating the immediate provision of crossmatched RBC units. Cell salvage was used to capture the blood shed during her procedure while the blood bank was searching for compatible RBCs units. Despite multiple interventions designed to optimize the cell salvage procedure for the unique challenges of a patient with SCD, the salvaged RBCs hemolyzed and could not be reinfused. Cell salvage in an obstetric patient with SCD in an acute crisis and superimposed HELLP was unable to recover intact and useable RBCs. Further studies into methods of optimizing the procedure for use in this context are warranted. Close communication between the clinical teams treating the patient and the transfusion service is required so that the RBC transfusion requirements can be anticipated; this is especially important when the patient has multiple antibodies.

Intraoperative red cell salvage during obstetric surgery in 50 Japanese women

ObjectiveTo determine the clinical usefulness of intraoperative cell salvage (ICS) in obstetrics. MethodsA retrospective analysis was performed using data for 50 patients who had received ICS blood during obstetric surgery at 13 Japanese facilities between January 1, 2007 and December 31, 2013. The frequencies of ICS-associated adverse events, allogeneic blood transfusion (ABT), and preoperative autologous donation (PAD) were assessed. ResultsPlacenta previa was the indication for ICS in 42 (84%) women. The ICS blood was reinfused in all women (median 366mL; range 80 to at least 3715). No ICS-associated adverse events occurred. The median estimated blood loss (EBL) was 2171mL (range 574–47 000); 27 (54%) women lost at least 2000mL. ABT was not used in 33 (66%) women. Among 26 women who lost at least 2000mL of blood and were included in analyses, 12 (44%) did not receive ABT. EBL was linearly correlated with the total volume of transfused blood (P<0.001). ConclusionICS caused no adverse events among women at elevated risk of peripartum hemorrhage and might be safe for use in obstetrics.

Economic evaluation of cell salvage in pediatric surgery

Red blood cells are a scarce resource with demand outstripping supply. Use of intraoperative red cell salvage (CS) - the process of collecting shed blood during surgery and reinfusing it to patients - is often used as an effective blood conservation strategy. However, little is known about the economic impact of CS during pediatric surgery. A decision tree model was used to estimate the transfusion-related costs per patient (2010 USD) from a healthcare system perspective of four transfusion strategies among children undergoing elective orthopedic or cardiac surgery: (i) CS followed by allogeneic transfusion, (ii) CS followed by autologous transfusion, (iii) allogeneic transfusion alone, and (iv) autologous transfusion alone. Cell salvage and allogeneic transfusion was the least expensive strategy (USD 883.3) followed by CS and autologous blood transfusion (USD 1,269.7), allogeneic transfusion alone (USD 1,443.0), and autologous transfusion alone (USD 1,824.7). Savings associated with CS use persisted in separate analyses of orthopedic and cardiac surgery, as well as in one-way and probabilistic sensitivity analyses. Use of CS, particularly along with allogeneic blood transfusion, appears cost-saving and cost-effective in pediatric surgery.

Role of Intraoperative Red Cell Salvage and Autologus Transfusion in Metastatic Spine Surgery: A Pilot Study and Review of Literature

Study DesignProspective cohort study.PurposeThere has been no research examining the use of intraoperative cell salvage during metastatic spinal surgery. The present work is a pilot study investigating the role of cell salvage during metastatic spine surgery.Overview of LiteratureThere is no spinal literature about role of cell salvage and autologus transfusion in metastatic spinal cancer.MethodsSixteen spinal metastases patients who received red cell salvage using a leucocyte depletion filter were enrolled. Of these, ten patients who received salvaged blood transfusion were included in the final analysis. Data collection involved looking at the case notes, operating room records and the prospectively updated metastatic spinal cancer database maintained in the spinal department. Cell salvage data was recovered from the central cell salvage database maintained in the anesthetic department.ResultsAmount of salvaged blood ranged from 120 to 600 mL (average, 318 mL). The average drop in hemoglobin was 1.65 units (range, 0.4-2.7 units). Three patients (30%) required postoperative allogenic blood transfusion. The average follow up was 9.5 months (range, 6-6 months). One patient developed new lung metastasis, at seven months. No patient developed new liver metastases. Preoperatively, six patients had diffuse skeletal metastases. Of this subgroup, three developed new skeletal metastases. No cases showed any wound related problems in the postoperative period.ConclusionsIn our study transfusion of intraoperatively salvaged blood did not result in disseminated metastatic cancer. We would suggest that red cell salvage might have a role during metastatic spine surgery.

Intraoperative red cell salvage in head and neck surgery

Intraoperative red cell salvage in head and neck surgery

Alloantibodies and Drug-Induced Immune Hemolytic Anemia in Liver Transplantation

Red blood cell alloantibodies can cause severe delayed hemolysis, despite immunosuppression which they receive posttransplantation. A female patient with Hepatitis C-related chronic liver disease reported to our center for liver transplantation. During preoperative evaluation, she was found to have significant red blood cell alloantibodies which gave rise to problems during pre transfusion compatibility test. Stringent measures were taken by the transplant team to minimize blood loss during surgery. It was decided to have lower transfusion trigger for red cell transfusion, and blood conservation was done by intraoperative red cell salvage and use of antifibrinolytic agent. During immediate postoperative period, she developed drug-related immune hemolytic anemia. Presence of both warm autoantibodies and alloantibodies posed a big challenge for us to get cross-match compatible blood. She received 22 units of crossmatch compatible red cell transfusions during her hospital stay, which was uneventful. Hence, we reported this case.

The need for Intra-operative cell salvage training to reduce the use of Allogeneic ‘bank’ Blood during Surgery. Is the routine adoption of a competency-based assessment in Intra-operative cell salvage required?

We performed a survey of all specialist registrars and their equivalents in the Imperial (North West Thames) region to assess their experience of and training in Intra-operative red cell salvage (ICS) and asked whether they would be confident to use ICS unsupervised for emergency out of hours work. 85% of respondents said that they would not be confident to set up or use ICS unsupervised.Allogeneic blood transfusion is expensive, associated with uncommon but potentially severe adverse consequences and of limited availability. Intra-operative red cell salvage (ICS) is a well-tried, cost effective method of reducing the use of allogeneic blood. Many organisations including the UK Blood Transfusion and Tissue Transplantation Service (www.transfusionguidelines.org) and the Association of Anaesthetists of Great Britain and Ireland have advocated the use of ICS for all suitable cases [1]. An operating department assistant (ODA) or anaesthetic nurse, with the appropriate experience, may set up the equipment but it will have to be supervised and used by an anaesthetist or, in a cardiac theatre, a Perfusionist. Anaesthetists with appropriate training and experience are therefore necessary if use of ICS is to be maximised. Allogeneic blood transfusion is expensive, associated with uncommon but potentially severe adverse consequences and of limited availability. Intra-operative red cell salvage (ICS) is a well-tried, cost effective method of reducing the use of allogeneic blood. Many organisations including the UK Blood Transfusion and Tissue Transplantation Service (www.transfusionguidelines.org) and the Association of Anaesthetists of Great Britain and Ireland have advocated the use of ICS for all suitable cases [1]. An operating department assistant (ODA) or anaesthetic nurse, with the appropriate experience, may set up the equipment but it will have to be supervised and used by an anaesthetist or, in a cardiac theatre, a Perfusionist. Anaesthetists with appropriate training and experience are therefore necessary if use of ICS is to be maximised.

Effect of antifibrinolytic drugs on transfusion requirement and blood loss during orthotopic liver transplantation: Results from a single center

Background:During orthotopic liver transplantation (OLT), activation of the fibrinolytic system can contribute significantly to perioperative bleeding. Prophylactic administration of antifibrinolytic agents has been shown to reduce blood loss and the need for allogenic transfusion.Objective:To study the effect of antifibrinolytics on requirement of blood components, blood loss and operative time during OLT in patients with end stage liver disease, reporting to a single centre.Materials and Methods:Consecutive patients who underwent OLT at this centre during the period February 2003-October 2007 were the subjects of this study. Based on the individual anesthesiologist's preference, patients were assigned to receive either two million units of aprotinin (AP) as a bolus followed by 5,00,000 units/hour or 10 mg/kg tranexamic acid (TA) as a bolus followed by 10 mg/kg every six to eight hours, administered from the induction till the end of the surgery. Transfusion policy was standardized in all patients. Intraoperative red cell salvage was done wherever possible. The effect of these two antifibrinolytic drugs on transfusion requirement was evaluated as a whole and in a sub group of patients from each treatment group and compared with a concurrent control group that did not receive antifibrinolytic drugs.Results:Fifty patients (40 M / 10 F, 44 adults, 6 pediatric patients) underwent OLT in the study period. Fourteen patients were given AP, 25 patients were given TA and 11 patients did not receive any of the agents(control group). The median volume of total blood components transfused in antifibrinolytic group (n = 39) was 4540 ml(0-19,200ml), blood loss 5 l(0.7-35l) and operative time 9h (4.5-17h) and that of control group(n = 11) was 5700 ml(0-15,500ml), 10 l(0.6-25 l) and 9h (6.4-15.8h) respectively. The median volume of blood transfusions, blood loss and operative time was lesser in AP group(n = 14) than that of TA group(n = 25).Conclusion:There is definite decrease in transfusion requirement, blood loss and operative time in the patients who received antifibrinolytic drugs than that of patients who did not receive. Because of the small sample size, comparisons carried between different groups did not show statistical significance. Prophylactic use of antifibrinolytics during OLT, possibly helps in blood conservation.

P06 Use of Intraoperative Red Cell Salvage During Elective Abdominal Aortic Aneurysm Repair is Safe and Associated with Reduced Need for Allogeneic Blood Transfusion.

Introduction The need for blood transfusion during vascular surgery can be considerable. Concerns regarding the safety and cost of allogeneic blood have demanded scrutiny of alternative methods of blood conservation during these operations, including intraoperative red cell salvage. Autotranfusion is purported to reduce the need for blood transfusion, and therefore its attendant complications.Method We retrospectively collected data on all patients undergoing elective infrarenal abdominal aortic aneurysm repair in our unit, and compared patients in which the cell saver was used to those in which it was not, in terms of operative blood loss, transfusion requirement, length of stay, and postoperative haemoglobin. The Mann Whitney test and Kendall's tau B statistics were used to analyse the dataResults Thirty‐five patients underwent AAA repair with use of the cell saver, and 31 patients underwent repair without the use of this device. We found a significant association between the use of the cell saver and reduced need for allogneic blood in these patients (Table). There was also a significant positive correlation between the volume of blood obtained by the cell saver, and that returned to the patient (t = +0.5, P &lt; 0.00001). The postoperative haemoglobin in the cell saver group was significantly lower, but still within acceptable range. There was no significant difference in mortality between the two groups; Variable Cell Saver Group ‐Mean No‐Cell Saver Group ‐ Mean Significance Age (years) 72.4 (8.1) 74.5 (7.1) 0.11 AAA size (cm) 6.2 (0.9) 6.1 (0.7) 0.94 Preop Hb (g/dL) 13.9 (1.2) 13.9 (1.6) 0.92 Operative blood loss (mL) 986.7 (494.2) 1900.6 (1657.6) 0.02 Intraoperative allogeneic blood used (no. units) 0.5 (1.2) 2.6 (2.8) &lt;0.0001 Total allogeneic blood (7d) 0.9 (1.4) 3.5 (4.3) &lt;0.0001 Post operative Hb 10.9 (1.2) 11.7 (1.7) 0.03 Length of stay (days) 12.5 (4.2) 10.7 (8.1) 0.01 Conclusion Our study indicates that use of the cell saver in elective AAA repair is associated with a reduced need for allogeneic blood transfusion, and therefore, with a reduction in risks of transmitted infection and transfusion reaction. These findings also have important financial implications.

The impact of intra-operative red cell salvage on allogeneic blood requirements following cardiac surgery

Spackman, D.; Powroznyk, A.; Naughton, C.; Vroemen, J.; Morley, A.; Feneck, R. O. Author Information

Facteurs associés à la stratégie transfusionnelle au cours des anesthésies programmées pour arthroplastie de hanche ou de genou en France

Goal of the study: To determine over a whole country what are the factors associated with an intraoperative homologous blood transfusion and with the use of autologous techniques (preoperative autologous blood donation : PABD; acute normovolemic hemodilution: ANVH; intraoperative red cell salvage: IRCS). Study design: National enquiry using a large representative sample (3 days of anaesthesia in France). Methods: Univariate followed by multivariate analyses of data gathered in 1996 during the survey leaded by the French society of anaesthesia and intensive care (Sfar) and corresponding to 884 scheduled hip and knee prosthesis surgical procedures. Results: Factors associated with a decreased use of PABD programme were: 1- old age and high ASA physical status; 2- procedures of short duration. By contrast, an increased use of PABD was associated with anaesthetics in which a closed circuit had been used. Except for a significant association with increasing age and with absence of PABD used, no additional factor was found to be linked with ANVH. No factor among those studied was found related to the use of IRCS. Homologous blood transfusion was more frequently used in ASA ≥ 3 patients, in long duration surgeries while its use was decreased in patients with PABD (odds ratio for reduction by PABD : 4.4 〚95 % confidence interval : 2.2-8.8〛). Homologous blood transfusion was not related to the use of ANVH or IRCS. Conclusion: These data obtained from a large national survey confirm previously published studies and meta-analyses and are in agreement with current recommendations. An unexpected relation between PABD and closed circuit anaesthesia has been found.

The effect of acute normovolaemic haemodilution on blood transfusion requirements in abdominal aortic aneurysm repair.

to evaluate the impact of acute normovolaemic haemodilution (ANH) on the blood transfusion requirements in elective abdominal aortic aneurysm (AAA) repair in a single vascular unit. thirty-two patients underwent ANH during elective AAA repair between 1992 and 1997. The operation was performed by the same surgeon/anaesthetist team in 75% of cases. Their demographic details, type of aneurysm (infra-renal or supra-renal), preoperative blood cross match, use of intra-operative red cell salvage, blood loss, peri-operative bank blood requirements, pre-op and on-discharge haemoglobin levels and post-operative outcome were recorded. The results were compared to a group of 40 randomly selected patients (to represent the unit average) who underwent elective AAA repair by variable surgeon/anaesthetist teams without ANH in the same time period. there were more supra-renal AAA repairs in the ANH group (8/32) than in the non-ANH group (0/40, p<0.01). ANH patients required significantly less blood transfusion peri-operatively (median 2 units) than the non-ANH patients (median 3 units, p=0.02). There were no other significant differences between the variables measured. these results suggest that a dedicated team can achieve significant reductions in the use of heterologous blood transfusion compared to the vascular unit average experience by the effective use of ANH.

Major surgery without blood transfusion

The practice of avoiding homologous blood transfusion has evolved from the desire to prevent disease transmission into a clinical technique with many patient benefits. These include improved immunological function, economic efficiency, and also patient choice.It is a technique that has benefits to offer patients with a wide range of pathologies, from multiple and rare alloantibodies, to carcinoma, and those undergoing surgery associated with massive blood loss. Familiarity and availability could see its wider application in major trauma, thereby reducing the burden on the blood transfusion service.Successful management of patients without blood transfusion requires knowledge of oxygen transport and the physiological response to anaemia. To avoid increasing patient risk, it is important not to exceed the tolerance limits of haemodilution. Patient selection is therefore essential in successfully avoiding blood transfusion.A number of strategies are available to reduce the need for blood transfusion. These strategies are maximally effective if combined to span the pre-operative, intra-operative, and post-operative periods. If time permits, pre-operative optimisation of haemoglobin is essential. Surgical, anaesthetic, and pharmacological techniques can reduce blood loss during surgery and must be employed.The peri-operative use of autologous blood reduces the incidence of homologous blood transfusion. Autologous blood can be procured from pre-operative donation, from acute normovolaemic haemodilution, and from intra-operative red cell salvage. Each technique has advantages and limitations. There is also a use for post-operatively collected autologous blood in appropriate circumstances.Continuing research is expanding the field of red cell substitutes that already offer limited benefit in avoiding blood transfusion.Major surgery without blood transfusion is an exciting and very real clinical prospect with many benefits for patient care. Success requires a well-planned team effort. As resources become more limited, this is a clinical technique that can only grow in its application.

Impact of Red Cell Salvage on Transfusion Requirements During Elective Abdominal Aortic Aneurysm Repair

Elective abdominal aortic aneurysm (AAA) surgery may result in substantial blood loss. Concerns regarding the safety, availability, and acceptability of homologous blood have led to initiatives toward reducing transfusion requirements at the time of aneurysm repair. This study was designed to determine if the routine use of intraoperative red cell salvage and autotransfusion resulted in a reduction in homologous transfusion at our institution. A retrospective review of elective AAA repairs in the years 1987, 1992, and 1997 was carried out. Demographic data, operative details, blood loss, hemoglobin levels, red cell salvage and return volumes, and transfusion requirements were recorded and compared across the study years. From this study we conclude that routine use of red cell salvage and autotransfusion is an effective means for reducing transfusion requirements in elective AAA repair.

The role of the transfusion medicine consultant.

Over the last 15 years, the field that was once known as blood banking has evolved into the discipline of transfusion medicine. Because of AIDS and a greater appreciation of other transfusion-transmitted diseases, attitudes toward transfusion therapy have changed significantly. Advances in the understanding of the pathophysiology of anemia and thrombocytopenia, as well as new tools for transfusion support have created new roles for the transfusion medicine physician. The transfusion medicine consultant has the opportunity to influence and improve transfusion safety, and contribute positively to cost containment by providing expertise as an educator, auditor of blood component usage, and providing leadership or oversight of therapeutic modalities (such as autologous transfusion, intraoperative red cell salvage, and therapeutic apheresis).