Retransfusion Of Autologous Blood Research Articles

Intraoperative Cell Savage, Infection and Organ Failure in Infective Endocarditis Patients-A Retrospective Single Center Evaluation.

Surgery is indicated in about 50% of infective endocarditis patients, and bleeding or the transfusion of blood a common finding. The intraoperative use of cell salvage may reduce the perioperative transfusion requirement, but its use is limited in the underlying disease. In this retrospective study, we therefore evaluated n = 335 patients fulfilling the modified Duke criteria for infective endocarditis characterized by the use of intraoperative cell salvage with autologous blood retransfusion. Inflammation markers and organ dysfunction, including catecholamine dependency, were evaluated by using linear regression analysis. Between 2015 and 2020, 335 patients underwent surgery for left-sided heart valve endocarditis. Intraoperative cell salvage was used in 40.3% of the cases, especially in complex scenarios and reoperation. Intraoperative cell salvage significantly altered the white blood cell count after surgery. On average, leucocytes were 3.0 Gpt/L higher in patients with intraoperative cell salvage compared to patients without after adjustment for confounders (95% CI: 0.39-5.54). Although the difference in WBC was statistically significant, i.e., higher in the ICS group compared to the no-ICS group, this difference may be clinically unimportant. Organ dysfunction, including hemodynamic instability and lactate values, were comparable between groups. In conclusion, intraoperative cell salvage enhanced the re-transfusion of autologous blood, with minor effects on the postoperative course of inflammatory markers, but was not associated with increased hemodynamic instability or organ dysfunction in general. The restriction of intraoperative cell salvage in surgery for infective endocarditis should be re-evaluated, and more prospective data in this topic are needed.

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

Oncological surgery, obstetric haemorrhage and severe trauma are the most challenging conditions for establishing clinical recommendations for the use of cell salvage. When the likelihood of allogeneic transfusion is high, the intraoperative use of this blood-saving technique would be justified, but specific patient selection criteria are needed. The main concerns in the case of oncological surgery are the reinfusion of tumour cells, thereby increasing the risk of metastasis. This threat could be minimized, which may help to rationalize its indication. In severe peripartum haemorrhage, cell salvage has not proven cost-effective, damage control techniques have been developed, and, given the risk of fetomaternal alloimmunization and amniotic fluid embolism, it is increasingly out of use. In trauma, bleeding may originate from multiple sites, coagulopathy may develop, and it should be evaluated whether re-transfusion of autologous blood collected from uncontaminated organ cavities would be feasible. General safety measures include washing recovered blood and its passage through leukocyte depletion filters. To date, no well-defined indications for cell salvage have been established for these pathologies, but with accurate case selection and selective implementation, it could become safe and effective. Randomized clinical trials are urgently needed.

Cell Salvage During Liver Transplantation for Hepatocellular Carcinoma: A Retrospective Analysis of Tumor Recurrence Following Irradiation of the Salvaged Blood

Orthotopic liver transplantation (OLT) is the treatment option for early-stage hepatocellular carcinoma (HCC). OLT is often associated with high blood loss, requiring blood transfusion. Retransfusion of autologous blood is a key part of blood conservation. There are, however, concerns that the retransfusion of salvaged blood might cause the spread of cancer cells and induce metastasis. Irradiation of salvaged blood before retransfusion eliminates viable cancer cells. Here, we analyzed the incidence of tumor recurrence in patients with HCC undergoing OLT who received irradiated cell-salvaged blood during transplant surgery. We retrospectively analyzed patients undergoing OLT for HCC between 2002 and 2018 at our center. We compared the tumour recurrence in patients who received no retransfusion of autologous blood with patients who received autologous blood with or without preceding irradiation of the blood. Fifty-one (40 male, 11 female) patients were included in the analysis; 10 patients developed tumor recurrence within a time period of 2.45 ± 2.0 years. Statistical analysis revealed that there was no significant difference in tumor recurrence between patients who received autologous blood with or without irradiation. Intraoperative transfusion of cell-salvaged blood did not increase tumor recurrence rates. Cell salvage should be used in liver transplantation of HCC patients as part of a blood conservation strategy. The effect of blood irradiation on tumor recurrence could not be definitively evaluated.

The effect of a novel turbulence-controlled suction system in the prevention of hemolysis and platelet dysfunction in autologous surgery blood.

Re-transfusion of autologous blood is an important aspect of intraoperative blood management. Hemolysis and platelet dysfunction due to turbulence in the blood suction system strongly impede later usage of suction blood for re-transfusion. The aim of this study was to analyze the effects of a novel surgical-blood suction system with an automatic control setup for minimization of turbulence in the blood flow. We compared the turbulence-controlled suction system (TCSS) with a conventional suction system and untreated control blood in vitro. Blood cell counts, hemolysis levels according to free hemoglobin (fHb) and platelet function were analyzed to determine the integrity of the suction blood. In the conventional suction system, we found a strong increase of the fHb levels. In contrast, erythrocyte integrity was almost completely preserved when using the TCSS. We obtained similar results regarding platelet function. The expression of platelet glycoproteins, such as GP IIb/IIIa and P-selectin, native or after stimulation with ADP, were markedly impaired by the conventional system, but not by the TCSS. In addition, platelet aggregometry revealed significant platelet dysfunction in conventional suction blood, but less aggregation impairments were present in blood samples from the TCSS. Our findings on an in vitro assessment show major improvements in red blood cell integrity and platelet function of suction blood when using the TCSS compared to a conventional suction system. These results reflect a significant benefit for autologous re-transfusion. We suggest testing the TCSS in surgery for clinical evaluation.

Neutrophil extracellular traps were released during intraoperative blood salvage in posterior lumbar surgery

The formation of neutrophil extracellular traps (NETs) has been associated with endothelial damage and severe pulmonary dysfunction. The present study aimed to investigate whether this NETosis occurs during intraoperative blood salvage (IBS), and whether the washing procedures before re-transfusion of autologous blood could remove the NET components, including DNA, histones, and myeloperoxidase. The study was performed using blood samples from 20 patients who underwent posterior lumbar surgery at the Beijing Friendship Hospital. The samples were obtained at three time points/sources: peripheral venous blood prior to surgery (baseline), cell salvage collection reservoir (reservoir), and filtered salvaged blood prior to re-transfusion (pre-transfusion); blood salvage was accomplished with a Cell Saver 5 system. The plasma was collected after centrifugation of the blood sample. Then the DNA amount was measured using SYTOX Green labeling; the integrity and length of the DNA were roughly evaluated by agarose gel electrophoresis; and the levels of nucleosomes (DNA and histones) and myeloperoxidase were detected using commercial ELISA kits. Extracellular DNA, nucleosomes, and myeloperoxidase were found higher in the reservoir samples and pre-transfusion samples, as compared to the baseline samples. The DNA was primarily non–fragmented with high molecular weight (>15 kb). And lower levels of these NET components were observed in pre-transfusion samples, compared with the reservoir samples. In conclusion, DNA, histones, and myeloperoxidase were released during IBS, indicating the NET formation by activated neutrophils. Pre-transfusion processing could reduce the NET components but the levels remained significantly elevated compared to the baseline.

Neutrophil extracellular traps were released during intraoperative blood salvage in posterior lumbar surgery

The formation of neutrophil extracellular traps (NETs) has been associated with endothelial damage and severe pulmonary dysfunction. The present study aimed to investigate whether this NETosis occurs during intraoperative blood salvage (IBS), and whether the washing procedures before re-transfusion of autologous blood could remove the NET components, including DNA, histones, and myeloperoxidase. The study was performed using blood samples from 20 patients who underwent posterior lumbar surgery at the Beijing Friendship Hospital. The samples were obtained at three time points/sources: peripheral venous blood prior to surgery (baseline), cell salvage collection reservoir (reservoir), and filtered salvaged blood prior to re-transfusion (pre-transfusion); blood salvage was accomplished with a Cell Saver 5 system. The plasma was collected after centrifugation of the blood sample. Then the DNA amount was measured using SYTOX Green labeling; the integrity and length of the DNA were roughly evaluated by agarose gel electrophoresis; and the levels of nucleosomes (DNA and histones) and myeloperoxidase were detected using commercial ELISA kits. Extracellular DNA, nucleosomes, and myeloperoxidase were found higher in the reservoir samples and pre-transfusion samples, as compared to the baseline samples. The DNA was primarily non-fragmented with high molecular weight (>15kb). And lower levels of these NET components were observed in pre-transfusion samples, compared with the reservoir samples. In conclusion, DNA, histones, and myeloperoxidase were released during IBS, indicating the NET formation by activated neutrophils. Pre-transfusion processing could reduce the NET components but the levels remained significantly elevated compared to the baseline.

Safety and efficacy of intraoperative cell salvage in off-pump coronary artery bypass grafting

Objectives Cell salvage and retransfusion of autologous blood has been shown to reduce the requirement for homologous blood transfusion during cardiac surgery. The adverse effects of blood transfusion are well-documented. Different techniques have been developed in the past to reduce homologous blood transfusion requirement. We evaluated the advantages of cell saver processed red blood cells which were to be used as autologous blood transfusion intra operatively and tried to avoid allogenic blood transfusion. We studied the safety and efficacy of this technique and determined the effects on haematological parameters, clotting parameters, homologous blood transfusion requirements, blood loss and postoperative parameters.

Impact of postoperative drainage autologous blood re-transfusion on the coagulation parameters and D-dimer levels of patients after total hip arthroplasty

BackgroundPostoperative drainage autologous blood re-transfusion (ABT) is an important treatment method that maintains a high haemoglobin (HGB) content and obviates the need for allogeneic blood transfusion in patients after surgery. However, the safety of ABT remains controversial. Objectives and methodsThis study aimed to investigate the safety of postoperative drainage ABT in primary total hip arthroplasty (THA). In this randomized, controlled study, patients undergoing THA were selected and randomly divided into two groups. A device for postoperative ABT was used for the 49 patients in the ABT group, whereas conventional postoperative vacuum drainage was used for the 42 patients in the drainage blood (Drain) group without ABT. The coagulation parameters and D-dimer (DD) levels of the two groups of patients were recorded before surgery (T0) and on postoperative days one (T1), three (T2), seven (T3), and 14 (T4). ResultsA within-group comparison after THA showed that the postoperative fibrinogen (FIB) and DD levels were higher than those before surgery in both groups (P < 0.01). A between-group comparison showed that, at different time points, the postoperative drainage blood amount and the coagulation parameters were not significantly different between the two groups. Compared with the Drain group, the DD levels in the ABT group were significantly higher at T1, T2, and T3 (P < 0.05). ConclusionPostoperative drainage ABT did not significantly impact the coagulation parameters of patients after THA. However, the DD levels after ABT significantly increased, which may affect the risk of thrombosis.

Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty: a randomised controlled trial.

A new intraoperative filtered salvaged blood re-transfusion system has been developed for primary total hip arthroplasty (THA) that filters and re-transfuses the blood that is lost during THA. This system is intended to increase postoperative haemoglobin (Hb) levels, reduce perioperative net blood loss and reduce the need for allogeneic transfusions. It supposedly does not have the disadvantages of intraoperative cell-washing/separating re-transfusion systems, such as extensive procedure, high costs and need for specialised personnel. To re-transfuse as much as blood as possible, postoperatively drained blood was also re-transfused. A randomised, controlled, blinded, single-centre trial was conducted in which 118 THA patients were randomised to an intraoperative autologous blood re-transfusion (ABT) filter system combined with a postoperative ABT filter unit or high-vacuum closed-suction drainage. On average, 577 ml of blood was re-transfused in the ABT group: 323 ml collected intraoperatively and 254 ml collected postoperatively. Hb level was higher in the ABT vs the high-vacuum drainage group: 11.4 vs. 10.8 g/dl, p = 0.02 on day one (primary endpoint) and 11.0 vs. 10.4 g/dl, p = 0.007 on day three. Total blood loss was less in the autotransfusion group: 1472 vs. 1678 ml, p = 0.03. Allogeneic transfusions were needed in 3.6 % of patients in the ABT group and 6.5 % in the drainage group, p = 0.68. The use of a new intraoperative ABT filter system combined with a postoperative ABT unit resulted in higher postoperative Hb levels and less total blood loss compared with a high-vacuum drain following THA.

Tranexamic acid obviates need for postoperatively salvaged autologous drainage blood retransfusion as part of a blood management programme for total hip and knee arthroplasty

Akromion Special Hospital for Orthopaedic Surgery, Dept of Anaesthesiology, Krapinske Toplice, Croatia

Influence of tranexamic acid on postoperative autologous blood retransfusion in primary total hip and knee arthroplasty: a randomized controlled trial

Postoperatively shed blood salvage is commonly used to reduce allogenic blood transfusion in patients undergoing total hip (THA) and knee arthroplasty (TKA). Autologous blood retransfusion is not devoid of risk. We hypothesized that adding tranexamic acid (TXA) to a restrictive blood transfusion protocol would reduce the need for postoperative autologous blood retransfusion in primary knee and hip arthroplasty. Ninety-eight adult patients undergoing primary THA or TKA were randomly assigned to receive an intraoperative intravenous loading dose of 1.0 g of TXA followed by another 1.0-g dose 3 hours later (TXA group) or a matching volume 0.9% saline placebo (control group). A postoperatively shed autologous blood recovery system was used in all patients and the minimum reinfusion volume set at 250 mL. Red blood cells were transfused if hemoglobin level was less than 8 or if 8 to 10 g/dL with symptoms of anemia. The proportion of patients receiving autologous blood reinfusion was significantly lower in the TXA group (5/49) compared to placebo (42/49) with an absolute difference of -75.5% (adjusted relative risk, 0.005), and none of the patients in the TXA group received more than 400 mL retransfused. Median total external blood loss during the first 24 hours was lower in the TXA group, 320 mL (range, 80-930 mL), compared to 970 mL (range, 100-2600 mL) in the placebo group (p < 0.001). There were no significant differences in homologous blood transfusions and hematologic variables between groups. Treatment differences were consistent by size and significance when the analysis was repeated separately in patients undergoing TKA or THA. Addition of TXA to a restrictive transfusion protocol makes the use of a postoperative blood salvage system in patients undergoing primary hip and knee arthroplasty unnecessary.

Five‐year study assessing the feasibility and safety of autologous blood transfusion in pregnant Japanese women

To assess the feasibility and safety of autologous blood donation during pregnancy in Japanese women. We enrolled patients who were either at high risk for massive blood loss during delivery or had blood that was difficult to match for transfusion between March 2005 and February 2010. After delivery, we reviewed hospital records of these patients to collect data on blood donation procedures, obstetric outcome and blood transfusions received. We enrolled 314 patients during the study period and performed 809 blood donations. The median volume of donated blood was 1200 mL (range, 400-2000 mL). Vasovagal reflex as an adverse donor reaction occurred in 10 of the 314 patients (3.2%) during 11 of the 809 donations (1.4%). There were no cases of non-reassuring fetal heart rate patterns during blood donations. Twenty-five (7.8%) of the 322 neonates were admitted to the neonatal intensive care unit. All 322 infants were healthy 1 month after delivery. Among 314 patients, autologous blood re-transfusion was performed for 56 (17.8%) and homologous blood transfusion was performed concurrently for 5 (1.6%). Placenta previa was the indication with the highest re-transfusion rate (42.4%). All re-transfusions were performed without side-effects. Autologous blood donation is feasible and safe for pregnant women and their infants. Although indications of autologous blood donation are controversial, it should be considered for cases of placenta previa.

Effect of Autologous Blood Transfusion on Cerebral Cytokine Expression

Autologous blood transfusion (ABT), for example, by means of cell saver equipment, is used to reduce the need for allogenic blood transfusion in patients with high perioperative blood loss. This study investigated the effect of blood/extracorporal surface interaction during withdrawal and retransfusion of shed autologous blood on cerebral inflammation in rats. Rats subjected to hypotension with cerebral ischemia served as positive controls. Eighty-eight male Sprague-Dawley rats were anesthetized with sevoflurane, instrumented, and randomly assigned to the following groups: sham-operation (SHAM), autologous blood withdrawal/transfusion only (ABT), or bilateral carotid artery occlusion and autologous blood withdrawal/transfusion (BCAO/ABT). Inflammatory gene expression was investigated with real-time RT-polymerase chain reaction at 6, 12, and 24 hours after SHAM, ABT, or BCAO/ABT in brain hippocampal tissue. Naive rats were investigated as reference. ABT alone had no impact on hippocampal inflammatory gene expression, whereas after BCAO/ABT tumor necrosis factor-alpha (10.7 fold at 24 h), interleukin-1β (2.1 fold at 6 h), interleukin-6 (35.7 fold at 24 h), COX-2 (9.3 fold at 6 h), and inducible nitric oxide synthase (3.4 fold at 24 h) increased compared with SHAM. ABT by itself did not provoke an inflammatory reaction in the healthy brain. However, in combination with cerebral ischemia the induction of a broad spectrum of inflammatory parameters indicates an inflammatory reaction of the hippocampus beginning after 6 hours and being most pronounced after 24 hours. Therefore, this study shows that cerebral inflammation is not induced by ABT after contact with extracorporal surfaces in rats.

Transfusion of intra-operative autologous whole blood: Influence on complement activation and interleukin formation

Transfusion of autologous whole blood is one available method to reduce the need for allogenic blood transfusion. The objective of this study was to investigate the safety of transfusion of intra-operative autologous whole blood by monitoring plasma concentration of laboratory variables and adverse events after transfusion with the Sangvia(®) system. The clinical trial was designed as an open, prospective, multi-centre study, and a total of 20 patients undergoing primary hip arthroplasty were included. Systemic blood samples were taken and analysed preoperatively, at transfusion start and end and at 3, 6, 24 and 48 h after the transfusion. Elevated values of complement activation and pro-inflammatory cytokines were seen in the intra-operatively collected blood but the impact on systemic levels were limited with low peak levels, systemic elevations before transfusion and normalization during the study period. Elevated levels of free haemoglobin and potassium were also detected in the intra-operatively collected blood, but systemic values were within reference values after the transfusion. No clinically relevant adverse event occurred during the study. Inflammatory mediators and plasma haemoglobin were increased in intra-operatively salvaged and filtered blood compared to circulatory levels. Intra-operative retransfusion of autologous whole blood caused a transient systemic increase that normalized in the early postoperative period. There were no significant adverse events reported in the study. These data suggest that the Sangvia(®) system can be used for intra-operative collection and retransfusion of salvaged blood.

Pre-operative injections of epoetin-α versus post-operative retransfusion of autologous shed blood in total hip and knee replacement

This prospective randomised clinical trial evaluated the effect of alternatives for allogeneic blood transfusions after total hip replacement and total knee replacement in patients with pre-operative haemoglobin levels between 10.0 g/dl and 13.0 g/dl. A total of 100 patients were randomly allocated to the Eprex (pre-operative injections of epoetin) or Bellovac groups (post-operative retransfusion of shed blood). Allogeneic blood transfusions were administered according to hospital policy. In the Eprex group, 4% of the patients (two patients) received at least one allogeneic blood transfusion. In the Bellovac group, where a mean 216 ml (0 to 700) shed blood was retransfused, 28% (14 patients) required the allogeneic transfusion (p = 0.002). When comparing Eprex with Bellovac in total hip replacement, the percentages were 7% (two of 30 patients) and 30% (nine of 30 patients) (p = 0.047) respectively, whereas in total knee replacement, the percentages were 0% (0 of 20 patients) and 25% (five of 20 patients) respectively (p = 0.042). Pre-operative epoetin injections are more effective but more costly in reducing the need for allogeneic blood transfusions in mildly anaemic patients than post-operative retransfusion of autologous blood.

A prospective randomised controlled trial of autologous retransfusion in total knee replacement

We undertook a prospective randomised controlled trial to investigate the efficacy of autologous retransfusion drains in reducing the need for allogenic blood requirement after unilateral total knee replacement. We also monitored the incidence of post-operative complications. There were 86 patients in the control group, receiving standard care with a vacuum drain, and 92 who received an autologous drain and were retransfused postoperatively. Following serial haemoglobin measurements at 24, 48 and 72 hours, we found no difference in the need for allogenic blood between the two groups (control group 15.1%, retransfusion group 13% (p = 0.439)). The incidence of post-operative complications, such as wound infection, deep-vein thrombosis and chest infection, was also comparable between the groups. There were no adverse reactions associated with the retransfusion of autologous blood. Based on this study, the cost-effectiveness and continued use of autologous drains in total knee replacement should be questioned.

Validation of a new arterial pulse contour-based cardiac output device

To evaluate the accuracy and precision of an arterial pulse contour-based continuous cardiac output device (Vigileo). Vigileo cardiac output (VigileoCO) was compared with intermittent transpulmonary thermodilution cardiac output (TPCO) and an established arterial pulse contour-based cardiac output (PCCO). Prospective clinical study. University hospital. Twenty-two patients undergoing coronary artery bypass graft surgery. Defined volume load during surgery and in the postoperative period. We obtained 184 pairs of VigileoCO and TPCO, 140 pairs of VigileoCO and PCCO, and 140 pairs of PCCO and TPCO. Measurements were performed after induction of anesthesia (T1), after sternotomy (T2), immediately after (T3) and 20 mins after volume challenge with 10 mL.kg hydroxyethyl starch 6% (T4), 15 mins after coronary pulmonary bypass (T5), after retransfusion of autologous blood (T6), after arrival at the intensive care unit (T7), and immediately after (T8) and 20 mins after (T9) a second volume load with 10 mL.kg hydroxyethyl starch 6%. TPCO was used to calibrate PCCO. For pooled data, including uncalibrated PCCO data immediately after weaning from coronary pulmonary bypass (T5), the correlation coefficient of TPCO vs. VigileoCO, PCCO vs. VigileoCO, and TPCO vs. PCCO was 0.75, 0.60, and 0.75 respectively. Bland-Altman analysis showed a bias of 0.00, -0.01, and 0.02 L.min, the precision (=sd) was 0.87, 1.08, and 0.93 L.min, and the mean error was 33%, 40%, and 35%. When we compared calibrated PCCO values (T2-T4, T6, T7-9), the correlation coefficients of PCCO-VigileoCO and TPCO-PCCO were 0.72 and 0.85, bias was -0.16 and 0.19 L.min, and mean error was 33% and 27%, respectively. Best correlations and the least differences between TPCO and VigileoCO were observed in postbypass closed-chest conditions and in the intensive care unit. Our results showed that VigileoCO enables clinically acceptable assessment of cardiac output in postbypass closed-chest conditions and during stable conditions in the intensive care unit.

Post-operative blood salvage with autologous retransfusion in primary total hip replacement

Clinical, haematological or economic benefits of post-operative blood salvage with autologous blood re-transfusion have yet to be clearly demonstrated for primary total hip replacement. We performed a prospective randomised study to analyse differences in postoperative haemoglobin levels and homologous blood requirements in two groups of patients undergoing primary total hip replacement. A series of 158 patients was studied. In one group two vacuum drains were used and in the other the ABTrans autologous retransfusion system. A total of 58 patients (76%) in the re-transfusion group received autologous blood. There was no significant difference in the mean post-operative haemoglobin levels in the two groups. There were, however, significantly fewer patients with post-operative haemoglobin values less than 9.0 g/dl and significantly fewer patients who required transfusion of homologous blood in the re-transfusion group. There was also a small overall cost saving in this group.

Autologous Predeposit: To Leukocyte Deplete Or Not to Leukocyte Deplete?

In five studies comparing different forms of storage of autologousblood the allogenic transfusion rate, humoral and cellular immuneparameters and the postoperative infection rate were investigated.In a prospective, randomized study 21 volunteers donated one unitof blood. Retransfusion of stored autologous whole blood, but notof autologous packed red cells and fresh frozen plasma, induced alimited response of the immune system. Four prospective, randomized,partially or totally blinded studies investigating autologous donationin primary hip arthroplasty were carried out: In the first studyincluding 94 patients, in which autologous blood was stored aswhole blood, leukocyte-depleted whole blood or as blood components,the allogenic transfusion rates were compared. The type ofstorage of autologous blood did not influence homologous transfusionrequirements. In a second study dealing with humoral immunefactors, 97 patients were allocated at random to two groups. In onegroup, the autologous donation was stored as whole blood, in theother group the donation was separated into blood components beforestorage. With respect to the parameters studied, there were nosignificant differences between patients transfused with wholeblood and those transfused with blood components. Moreover,these values also did not differ from those of patients not transfused.In a third study, the phagocytosis and respiratory burst activityof neutrophil granulocytes and of monocytes was measured in58 patients who were randomly allocated to two groups as in theprevious study. Neither the time course of phagocytosis nor that ofrespiratory burst activity showed a significant difference betweenboth groups. In a fourth multicenter study, 953 patients were allocatedto either of two groups. The first group of patients receivedautologous blood stored as whole blood, in the second groupleukocyte depletion was done before storage. When comparing theoutcomes of both groups, it could be shown that leukocyte depletionof autologous whole blood did not reduce the number of postoperativeinfections in primary hip surgery. It is therefore concludedthat neither leukocyte depletion nor blood component separationis mandatory when using autologous predeposit in primary hiparthroplasty.

Augmented acute normovolemic hemodilution (A-ANH TM ) -

Augmented Acute Normovolemic Hemodilution serves to reduce the need for allogeneic blood transfusions in patients undergoing high blood loss surgery. Augmented acute normovolemic hemodilution has 3 phases: First, acute normovolemic hemodilution prior to surgical blood loss, second, administration of an artificial O2 carrier such as a modified hemoglobin solution or perflubron emulsion during periods of low endogenous hemoglobin concentration during surgery and third, re-transfusion of autologous blood after the operation. Efficacy remains to be ultimately proven in clinical trials but mathematical modeling indicates that clinically significant reductions in allogeneic blood transfusions are likely.