Reinfusion Of Red Blood Cells Research Articles

Intraoperative red blood cell salvage in cancer surgery

Surgery in cancer patients may sometimes involve significant blood loss, and intraoperative red blood cell salvage is an effective technique that can reduce postoperative complications. Autologous reinfusion of red blood cells processed by a cell saver machine significantly reduces the number of red blood cell transfusions from donors. The use of leukocyte filters eliminates the possibility of tumor cell release into the patient’s circulation. This method is easy to use, however medical staff should be appropriately trained in cell salvage. Intraoperative red blood cell salvage can and should be used in the management of patients undergoing planned or emergency surgeries with expected blood loss > 500 mL.

Sangre autóloga a reinfundir con el recuperador celular a pacientes cardíacos en respuesta a las transfusiones sanguíneas

Introduction and objetivesThe cell saver is an alternative to blood transfusions according to the existing evidence. However, there is no evidence to determine the time of reinfusion of red blood cells in line with transfusions. Our objective was to analyze the evidence on the effectiveness of the cell saver to reduce blood transfusions. MethodsRandomized clinical trial with 91 patients in a non-exposed group (reinfusion of autologous blood with the cell saver was performed at the end of surgery) and 80 patients exposed group (reinfusion of autologous blood was performed continuously during surgery). Variables were collected at three moments (preoperative, intraoperative and postoperative). ResultsBoth haemoglobin and haematocrit were lower in the unexposed group when compared to the exposed group, both during after surgery (p=.011 and.018, respectively), and blood transfusions were higher in the unexposed group both during, and after surgery (p=.001). ConclusionsIn order to reduce the transfusion rate of cardiac patients as much as possible, the optimal time to reinfuse autologous blood from the cell saver should be during the surgery, according to a continuous reinfusion protocol.

Therapeutic Plasma Exchange - An Emerging Treatment Modality in Patients with Neurologic and Non-Neurologic Diseases.

Therapeutic Plasma Exchange (TPE) is a procedure in which the patient's blood is passed through an apheresis machine, where the filtered plasma is removed and discarded with reinfusion of red blood cells along with replacement fluid such as plasma or albumin in to the patient. We present our experience with TPE in treatment of various neurologic and non-neurologic diseases. To evaluate TPE as primary therapy or as a first-line adjunct to other initial therapies as mentioned by American Society for Apheresis (ASFA). A retrospective analysis of TPE procedures was done for a period of nine years, from January 2007 to May 2016 in a tertiary care teaching hospital. A total of 584 TPE procedures were performed in 161 patients between 2 to 75 years of age. Clinical and laboratory investigations like ECG, chest X-ray, cardiorespiratory status and serology were carried out before the TPE procedure. A total of 161 patients were enrolled in the present study. Guillain-Barre Syndrome (GBS) (67.7%, n=109) was the main indication for TPE, followed by Myasthenia Gravis (MG) (13.04%, n=21). Overall incidence of adverse reactions was 9.93%, inadequate vascular access was a common complication encountered in paediatric age group. Our results show that TPE is not only safe and effective treatment alternative to Intravenous Immunoglobulin (IVIG), it also strongly holds evidence in the improvement of neurological disorders compared to non-neurological disorders. There is need of further detail evaluation on large number of cases for proper evidence based practice.

Autologous Doping with Cryopreserved Red Blood Cells - Effects on Physical Performance and Detection by Multivariate Statistics.

The discovery of erythropoietin (EPO) simplified blood doping in sports, but improved detection methods, for EPO has forced cheating athletes to return to blood transfusion. Autologous blood transfusion with cryopreserved red blood cells (RBCs) is the method of choice, because no valid method exists to accurately detect such event. In endurance sports, it can be estimated that elite athletes improve performance by up to 3% with blood doping, regardless of method. Valid detection methods for autologous blood doping is important to maintain credibility of athletic performances. Recreational male (N = 27) and female (N = 11) athletes served as Transfusion (N = 28) and Control (N = 10) subjects in two different transfusion settings. Hematological variables and physical performance were measured before donation of 450 or 900 mL whole blood, and until four weeks after re-infusion of the cryopreserved RBC fraction. Blood was analyzed for transferrin, iron, Hb, EVF, MCV, MCHC, reticulocytes, leucocytes and EPO. Repeated measures multivariate analysis of variance (MANOVA) and pattern recognition using Principal Component Analysis (PCA) and Orthogonal Projections of Latent Structures (OPLS) discriminant analysis (DA) investigated differences between Control and Transfusion groups over time. Significant increase in performance (15 ± 8%) and VO2max (17 ± 10%) (mean ± SD) could be measured 48 h after RBC re-infusion, and remained increased for up to four weeks in some subjects. In total, 533 blood samples were included in the study (Clean = 220, Transfused = 313). In response to blood transfusion, the largest change in hematological variables occurred 48 h after blood donation, when Control and Transfused groups could be separated with OPLS-DA (R2 = 0.76/Q2 = 0.59). RBC re-infusion resulted in the best model (R2 = 0.40/Q2 = 0.10) at the first sampling point (48 h), predicting one false positive and one false negative. Over all, a 25% and 86% false positives ratio was achieved in two separate trials. In conclusions, autologous re-infusion of RBCs increased VO2max and performance as hypothesized, but hematological profiling by multivariate statistics could not reach the WADA stipulated false positive ratio of <0.001% at any time point investigated. A majority of samples remained within limits of normal individual variation at all times.

Reduction of allogeneic red blood cell usage during cardiac surgery by an integrated intra‐ and postoperative blood salvage strategy: results of a randomized comparison

The amount of allogeneic blood transfusion may relate to worse outcome in cardiac surgery. The reinfusion of red blood cells (RBCs) lost by patients, including those of chest drains, is a promising strategy to minimize allogeneic transfusions. To verify this hypotheis, 1047 cardiac surgery patients were randomly assigned to either traditional intraoperative blood salvage followed by chest drain insertion or intra- and postoperative strategy with the Haemonetics cardioPAT system. Allogeneic RBC transfusion rate (primary endpoint) and postoperative complications (secondary endpoint) were recorded at the time of discharge from the hospital and at first month follow-up visit, respectively. The cardioPAT arm received 1.20 units of allogeneic RBCs per patient, whereas the control group required 2.11 units per patient, and this difference proved to be highly significant (p=0.02). We observed a comparable 45-day mortality rate but a lower rate of deep vein thrombosis (p=0.04) and atrial fibrillation (p=0.04) in the cardioPAT arm. A significant reduction in patient exposure to allogeneic RBCs was observed in the cardioPAT system arm. Complications were slightly less frequent in the cardioPAT group. The use of the cardioPAT is a safe and effective strategy to reduce allogeneic RBC transfusions in cardiac surgery.

The Swedish Blood Pass project

Manipulation of the blood's oxygen carrying capacity (CaO(2)) through reinfusion of red blood cells, injections of recombinant erythropoietin or by other means results in an increased maximal oxygen uptake and concomitantly enhanced endurance performance. Therefore, there is a need to establish a system--"A Blood Pass"--through which such illegal and unethical methods can be detected. Venous blood samples were taken under standardized conditions from 47 male and female Swedish national and international elite endurance athletes four times during the athletic year of the individual sport (beginning and end of the preparation period and at the beginning and during peak performance in the competition period). In these samples, different hematological values were determined. ON(hes) and OFF(hre) values were calculated according to the formula of Gore et al. A questionnaire regarding training at altitude, alcohol use and other important factors for hematological status was answered by the athletes. There were some individual variations comparing hematological values obtained at different times of the athletic year or at the same time in the athletic year but in different years. However, the median values of all individual hematological, ON(hes) and OFF(hre), values taken at the beginning and the end of the preparation or at the beginning and the end of the competition period, respectively, as well as median values for the preparation and competition periods in the respective sport, were all within the 95% confidence limit (CI) of each comparison. It must be mentioned that there was no gender difference in this respect. This study shows that even if there are some individual variations in different hematological values between different sampling times in the athletic year, median values of important hematological factors are stable over time. It must be emphasized that for each blood sample, the 95% CI in each athlete will be increasingly narrower. The conclusion is that there is a physiological basis for establishing an individual-based "Blood Pass" system, mainly for athletes competing at the international level. On indications of manipulations of hemoglobin concentration and red cell mass by deviations from established "Blood Pass" data, more specific methods can be applied.

Heparin content of washed red blood cells from the cardiopulmonary bypass circuit

Reinfusion of red blood cells (RBC) from the extracorporeal circuit following cardiopulmonary bypass (CPB) reduces patient exposure to homologous blood. Because infusing unneutralized heparin might exacerbate postoperative bleeding, this study examines the heparin content of the washed packed RBC produced by a commonly used autotransfusion device. This RBC product was derived from the residual whole blood in the oxygenator circuit after CPB. A wash volume of 750 mL of normal saline produced heparin concentrations below 0.04 USP U/mL. A 500 mL wash volume yielded heparin concentrations ranging from 0.08 to 0.22 USP U/mL, and could be used if time did not permit an additional wash. RBCs produced by the usual complete wash cycle do not contain clinically significant amounts of heparin; thus, they would not require a supplemental protamine dose.

Blood volume and hemoglobin concentration as determinants of maximal aerobic power

Changes in blood volume (BV) and hemoglobin concentration ( [Hb] ) were induced in five healthy young men. After acute hypovolemic anemia was achieved by blood withdrawal, VO2max values decreased, while the same [Hb] due to acute plasma volume expansion (6% dextran) did not alter VO2max. After reinfusion of red blood cells, leading to hypervolemia and increased [Hb], VO2max increased. Plasma volume expansion in this situation, leading to hypervolemia at normal [Hb], resulted in a slight reduction in VO2max, which, however, remained elevated (approximately 4%) above control values. Physical performance, measured as time to exhaustion, corresponded to the changes in VO2max except for the hypervolemic anemic situation, where it decreased. Changes in peak heart rate were inversely related to BV changes, but were also influenced by [Hb]. The results point to a significant influence of the total amount of Hb rather than the blood hemoglobin concentration for obtaining a high maximal aerobic power. Thus, a reduced [Hb], concomitantly with an elevated blood volume (plasma volume), may result in an unchanged VO2max, but reduced performance time.

Blood flow and O2 uptake in dog hindlimb with anemia, norepinephrine, and propranolol.

To examine the relative importance of 1) reduced blood viscosity, 2) vasodilation mediated through beta-adrenergic receptors, and 3) sympathetic nerve activity on the regulation of limb blood flow during anemia, norepinephrine (NE) was infused in 10 anesthetized-paralyzed dogs at normal and reduced hematocrit (Hct). Cardiac output (QT), limb and total oxygen uptake (VO2)n and limb venous flow (QL) were determined. After a control period, NE (2 micrograms . kg-1 . min-1) was infused followed by another control period. The Hct was then reduced to 9% by isovolemic hemodilution with dextran, and data were obtained during anemia, anemia plus NE, and after isovolemic reinfusion of red blood cells (Hct 25%) during NE. Another 10 dogs were treated identically after propranolol (1.0 mg/kg) administration. At normal Hct, NE increased limb resistance (RL) (P less than 0.01) in the beta-block group; a decrease in RL (P less than 0.05) and a rise in QL (P less than 0.01) occurred in the no block group. QL and VO2 (limb and total) were not changed by NE. During anemia, RL was not altered in either group by NE; QT fell (P less than 0.05) in both, and QL decreased in the no block group. After reinfusion of cells, NE produced an increase in RL and total peripheral resistance (P less than 0.01) and a fall in QL (P less than 0.01) and QT (P less than 0.01) in both groups; limb and total VO2 rose in the no block group. We conclude that the reduction in viscosity prevented an increase in both RL and redistribution of QL during severe anemia (Hct 9%).

Central circulation during exercise after venesection and reinfusion of red blood cells.

To study central circulation at different levels of hemoglobin (Hb) concentration, five subjects performed submaximal and maximal exercise in three different situations: 1) control, 2) after venesection of 800 ml of whole blood, and 3) after reinfusion of the red blood cells about 30-35 days after venesection. Maximal oxygen uptake (VO2 max) decreased from 4.27 l-min-1) at control to 4.03 l-min-1 after venesection (P less than 0.05) and increased to 4.61 l-min-1 after reinfusion (P less than 0.05). Maximal values on cardiac output (Q), heart rate (HR), and stroke volume (SV) were the same in the three situations. Thus, there was no compensatory increase in Qmax due to the lowered arterial oxygen content (Cao2) after venesection. An increase of the Cao2 (Hb concentration) and a lowering of the Cvo2 contributed equally to the increased VO2 max after reinfusion. At a given submaximal VO2, HR and blood lactates were increased at lowered Hb concentration and decreased at increased Hb concentration over control levels. Correlation coefficient for the change in Q in relation to the acute change in Hb concentration at a given submaximal VO2 was -0.49 (P less than 0.05).