Effect of intraoperative cell salvage on allogeneic blood transfusion requirements, coagulation function and electrolytes in postpartum hemorrhage of cesarean section / 中国输血杂志

【Objective】 To explore the effect of intraoperative cell salvage on allogeneic blood transfusion requirements, coagulation function and electrolytes in postpartum hemorrhage patients. 【Methods】 A study on postpartum hemorrhage patients undergoing cesarean section in the Third Affiliated Hospital of Guangxi Medical University form September 2016 to May 2022 was conducted retrospectively. A total of 137 patients were enrolled and divided into experimental group (n=70) and control group (n=67) according to whether intraoperative cell salvage was used during operation. The blood loss, proportion and volume of allogeneic red blood cells (RBCs) and coagulation component transfusion, hemoglobin (Hb) level, coagulation function, electrolyte, the incidence of complications, proportion of ICU admission, ICU stay and in-hospital stay were compared between the two groups. 【Results】 The proportion of patients receiving allogeneic RBCs in the experimental group and in the control group was 31.4% vs 100.0% (P0.05). 【Conclusion】 This study demonstrated that intraoperative cell salvage could reduce the requirement for allogeneic RBCs without compromising coagulation function in postpartum hemorrhage patients undergoing cesarean section, but the changes of calcium need to be concerned after transfusion.

Application and risk assessment of intraoperative cell salvage in patient with malignancy / 中国输血杂志

Patients with malignant tumour often require massive transfusion. Intraoperative cell salvage(IOCS) was initially limited in cancer surgery by concerns about the possibility of dissemination of tumor cells into circulation. However, as supportive literature concerning IOCS research and application in cancer surgery are increasing, it is necessary to reassess the perioperative application of IOCS in patients with malignancy. This review summarizes the application, risks and value of IOCS during cancer operations.

Removal oftumor cells from blood by leukocyte filter / 中国输血杂志

【Objective】 To investigate the effect of leukocyte filter in removal of tumor cells in blood and the viability of using leukocyte filter in intraoperative cell salvage in tumor patients. 【Methods】 The leucocyte-depleted suspended RBCs prepared from 200 mL human whole blood were spiked with HCT116 cells cultured in vitro to simulate the autologous blood recovered from tumor patients during operation. Conventional filter (group A, n=6), filter with small pore size (group B, n=6) and filter with thicker membrane and small pore size (group C, n=6)) were used. The CD45-EpCAM+ tumor cells were detected by anti-CD45-PE and anti-CD326 (EpCAM)-FITC flow cytometry, and the absolute count of tumor cells were calculated using Flow Count fluorescence microspheres. The activity of tumor cells was detected by cell culture and trypan blue staining. Furthermore, blood biochemical indexes (LDH, K+ ) and red cell recovery rate were detected. 【Results】 Tumor cell counts before and after the application of leukocyte filter A, B, C were(1.52±0.48)×107/mL vs(2.73±1.74)×104/mL, (1.48±0.55)×107/ml vs(2.96±1.85)×104/mL and (1.44±0.46)×107/mL vs(3.08±2.33)×104/mL, respectively (P >0.05), which was significantly reduced after filtration (P < 0.01). No viable cells were found in the filtered blood cultured for 7 days. There were no significant differences in K+ and LDH value before and after filtration among the three groups(P >0.05). The blood recovery rates of group A, B, C were 85.22%, 84.97% and 82.86%, respectively. 【Conclusion】 The conventional filter can significantly reduce the number of circulating tumor cells, and it is feasible for intraoperative cell salvage in tumor patients.

Clinical Efficacy of Intra-Operative Cell Salvage System in Major Spinal Deformity Surgery

OBJECTIVE: The purpose of this study was to determine the efficacy of intra-operative cell salvage system (ICS) to decrease the need for allogeneic transfusions in patients undergoing major spinal deformity surgeries.METHODS: A total of 113 consecutive patients undergoing long level posterior spinal segmental instrumented fusion (≥5 levels) for spinal deformity correction were enrolled. Data including the osteotomy status, the number of fused segments, estimated blood loss, intra-operative transfusion amount by ICS (Cell Saver®, Haemonetics©, Baltimore, MA, USA) or allogeneic blood, postoperative transfusion amount, and operative time were collected and analyzed.RESULTS: The number of patients was 81 in ICS group and 32 in non-ICS group. There were no significant differences in demographic data and comorbidities between the groups. Autotransfusion by ICS system was performed in 53 patients out of 81 in the ICS group (65.4%) and the amount of transfused blood by ICS was 226.7 mL in ICS group. The mean intra-operative allogeneic blood transfusion requirement was significantly lower in the ICS group than non-ICS group (2.0 vs. 2.9 units, p=0.033). The regression coefficient of ICS use was -1.036.CONCLUSION: ICS use could decrease the need for intra-operative allogeneic blood transfusion. Specifically, the use of ICS may reduce about one unit amount of allogeneic transfusion in major spinal deformity surgery.

Clinical Efficacy of Intra-Operative Cell Salvage System in Major Spinal Deformity Surgery

OBJECTIVE: The purpose of this study was to determine the efficacy of intra-operative cell salvage system (ICS) to decrease the need for allogeneic transfusions in patients undergoing major spinal deformity surgeries. METHODS: A total of 113 consecutive patients undergoing long level posterior spinal segmental instrumented fusion (≥5 levels) for spinal deformity correction were enrolled. Data including the osteotomy status, the number of fused segments, estimated blood loss, intra-operative transfusion amount by ICS (Cell Saver®, Haemonetics©, Baltimore, MA, USA) or allogeneic blood, postoperative transfusion amount, and operative time were collected and analyzed.

Patient Blood Management: Obstetrician, Gynecologist's Perspectives / 한양의대학술지

Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patient blood management (PBM). We will review to summarize the alternative measures and interventions used in bloodless surgery in the field of obstetrics and gynecology. In the obstetric field, PBM has been developed as an evolving evidence-based approach with a number of key goals: (i) to identify, evaluate, and manage anemia; (ii) reduce iatrogenic blood loss; (iii) optimize hemostasis; and (iv) establish decision thresholds for transfusion. Transfusion, mechanical method including balloon tamponade and uterine artery embolization, and intraoperative cell salvage were introduced for PBM. In the gynecologic field, PBM is not significantly different from that in the obstetric field. Preoperative managements include iron supplement, erythropoietin administration, autologous blood donation, and uterine artery embolization. Meticulous hemostasis, short operative time, hypotensive anesthetic techniques, hemodilution during operation, blood salvage and pharmacological agents were introduced to intraoperative management. Postoperative measures include meticulous postoperative monitoring of the patient, early detection of blood loss, reduction of blood sampling, appropriate use of hemopoiesis, normalization of cardio-pulmonary function and minimization of oxygen consumption. In conclusion, each obstetrician and gynecologist should be aware about the appropriate method for blood conservation and use in practice. A comprehensive approach to coordinating all members of the bloodless agent and surgical team is essential.

Two-year experience with cell salvage in total hip arthroplasty / Dois anos de experiência com recuperação intraoperatória de sangue em artroplastia total do quadril

ABSTRACT BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53 ± 111.88 mL) than that in the control group (170.14 ± 116.79 mL; p < 0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37 ± 193.33 mL) than the control group (152.22 ± 208.37 mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n = 29; 43.2%) was also significantly lower than control group (n = 56; 73.6%; p < 0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

RESUMO JUSTIFICATIVA E OBJETIVO: Determinar a eficácia do sistema de recuperação intraoperatória de sangue em artroplastia total de quadril e se o sistema de recuperação intraoperatória de sangue pode reduzir a necessidade de transfusão de sangue alogênico em pacientes submetidos à artroplastia total de quadril. MÉTODOS: Análise retrospectiva dos prontuários de pacientes submetidos a cirurgias de artroplastia de quadril entre 2010 e 2012 em um hospital universitário. Foram inscritos no estudo 181 pacientes submetidos à artroplastia. RESULTADOS: A média da taxa de transfusão de sangue alogênico no período perioperatório foi significativamente inferior no grupo de recuperação intraoperatória de sangue (92,53 ± 111,88 mL) do que no grupo controle (170,14 ± 116,79 mL; p < 0,001). Quando as médias das taxas de transfusão no pós-operatório foram comparadas, o grupo de recuperação intraoperatória de sangue apresentou valores inferiores (125,37 ± 193,33 mL) aos do grupo controle (152,22 ± 208,37 mL), embora a diferença não tenha sido estatisticamente significativa. O número de pacientes que recebeu transfusão de sangue alogênico no grupo RC (n = 29; 43,2%) também foi significativamente inferior ao do grupo controle (n = 56; 73,6%; p < 0,05). Na análise de regressão logística, a quantidade de transfusão no período perioperatório, a razão de chance (OR) -4,257 (95% CI -0,502-0,184) e o tempo cirúrgico OR: 2,720 (IC 95% 0,001-0,004) foram fatores de risco independentes para o uso de sistema de recuperação intraoperatória de sangue. CONCLUSÃO: A recuperação intraoperatória de sangue é uma estratégia eficaz para reduzir a necessidade de transfusão de sangue alogênico no período perioperatório, que auxilia no manejo sanguíneo durante as intervenções. Portanto, recomendamos o sistema de recuperação intraoperatória de sangue para uso em artroplastia total de quadril para diminuir a necessidade de transfusão de sangue alogênico, quando possível.

Implementation of an obstetric cell salvage service in a tertiary women's hospital

<p><b>INTRODUCTION</b>Intraoperative cell salvage (ICS) is an important aspect of patient blood management programmes. An ICS service was introduced at KK Women's and Children's Hospital, Singapore, from 2 May 2011 to 30 April 2013 to aid in the management of massive obstetric haemorrhage.</p><p><b>METHODS</b>With support from the Ministry of Health's Healthcare Quality Improvement and Innovation Fund, a workgroup comprising obstetricians, anaesthetists and nursing staff was formed to develop training requirements, clinical guidelines and protocols for implementing ICS using the Haemonetics Cell Saver 5. Pregnant women with an anticipated blood loss of > 1,000 mL during Caesarean delivery, a baseline haemoglobin level of < 10 g/dL, rare blood types and who had refused donor blood were recruited to the service after obtaining informed consent.</p><p><b>RESULTS</b>A total of 11 women were recruited to the ICS service; the primary indications were placenta praevia and placenta accreta. Median blood loss in these 11 patients was 1,500 (range 400-3,000) mL. In four patients, adequate autologous blood was collected to initiate processing and salvaged, processed blood was successfully reinfused (mean 381.3 [range 223.0-700.0] mL). Median blood loss among these four patients was 2,000 (range 2,000-3,000) mL. No adverse event occurred following autologous transfusion. Mean immediate postoperative haemoglobin level was 8.0 (range 7.1-9.4) g/dL.</p><p><b>CONCLUSION</b>The implementation of an obstetric ICS service in our institution was successful. Future studies should seek to address the cost-effectiveness of ICS in reducing allogeneic blood utilisation.</p>

Influence of CATS and Cell Saver on hemorheology and blood quality of intraoperative cell salvage in orthopaedic surgery / 重庆医学

Objective To observe recycle homorheology index of two autologous blood recover machines in orthopedic operation , including maximum deformation index (DImax) ,aggregation index(AImax) ,osmotic fragility ,hematocrit(Hct) ,hemoglobin(Hb) , blood electrolytes and pH value ,the changes of in vivo Hct ,Hb ,blood electrolyte and pH value after the autotransfusion to provide references for rational clinical use of cell salvage .Methods Seventy‐six patients were randomly divided into group A (CATS) and group B (Cell Saver) ,38 cases in each group .Autologous test of DImax ,AImax ,osmotic fragility ,Hct ,Hb ,blood electrolytes ,pH value and Hct ,Hb ,osmotic fragility ,pH value of patients before and after autotransfusion ,24 h after operation ,used to determine the in vivo salvaged were measured .Results DImax of group A were lower than that of group B with no difference(P0 .05) ,but was lower than the reference value .RBC osmotic fragility curve shifted to the right in group A ,each index was significantly lower than its reference value(P0 .05) .The in vivo Hct of both groups after autotransfusion were significantly higher than before(P<0 .05) .Conclusion The hemorheology index and quality of salvaged blood acquired from these two cell salvage systems in orthopae‐dic operation have no obvious differences .The function of these two kinds of cell salvage systems is safer and reliable .

Effects of acute hypervolemic hemodilution and intra-operative cell salvage on orthopedic surgery patients / 中华创伤杂志

Objective To evaluate impacts of acute hypervolemic hemodilution (AHH) and intra-operative cell salvage (ICS) with 6％ volume fraction of hydroxyethyl starch (HES) on hemodynamics,blood saving efficiency and renal function of orthopedic surgery patients.Methods A total of 58 patients from orthopedic surgery were involved and randomly divided into AHH + ICS group (30 cases) and control group (28 cases).Changes of hemodynamic indices (HR,MAP and CVP) and renal function indices (BUN,BCr,UCr and ALB) in both groups were compared before operation (T0),immediately after operation (T1) and at postoperative 4 hours (T2),1 day (T3) and 2 days (T4).CCr was counted and intraoperative blood conservation was observed at each time point as well.Results HR,MAP and CVP of the two groups had no significant differences.Both groups showed some drop of HR (P ＜ 0.05),but an increase of MAP and CVP at T1-T4 (P ＜ 0.05),in contrast with levels at TO.BUN,BCr and ALB also showed insignificant differences between groups or within group at each time point.CCr in the control group showed no significant difference at each time point.On the contrary,CCr in the AHH + ICS group had a fall at T1-T4 and was declined to the lowest level at T2.CCr in the AHH + ICS group showed a recovery at T3-T4 and its level at T4 was still lower than that at TO,with no significant difference.CCr in the two groups showed insignificant difference at TO,but its level in the AHH + ICS group was lower than that in the control group at T1-T4,at T2 in particular (P ＜0.01).Moreover,CCr in the two groups was still significantly different at T4 (P ＜ 0.05).Renal function indices of the two groups were all within normal range at each time point.Intraoperative blood loss and unrine volume of the two groups had no significant differences,but intraoperative fluid requirement,allogenic blood transfusion volume and transfusion rate of AHH + ICS group were notably lower than those of control group (P ＜ 0.05 or P ＜0.01).Conclusions AHH plus ICS using HES are safe,effective and promising integrated blood conservation measures,which significantly reduces intraoperative allogenic blood transfusion volume and transfusion rate and has few impacts on fundamental vital signs and renal function.However,prolonged use of large dose of HES may do harm to renal function and therefore should be carefully considered in treatment of patients with severe renal dysfunction.

Suction conditions for minimizing the production of free hemoglobin during blood salvage using an autotransfusion apparatus / 대한마취과학회지

BACKGROUND: Three kinds of conditions should be considered to reduce free hemoglobin production using an autologous cell salvage device. They are the negative suction pressure, the size of suction tip, and the air contact during suction. We want to examine which condition is the most important factor to produce free hemoglobin. METHODS: One pack of red blood cell and one pack of fresh frozen plasma with the same blood type were mixed. They were aspirated based on the two suction pressure (-150 mmHg or -300 mmHg), three sizes of suction tips, and the two conditions of air contact, in which the suction tip was located in the surface of blood or in the middle of the blood. Seven ml sized EDTA tube was used to collect 5 ml blood. All the procedure repeated ten times. Free hemoglobin, total hemoglobin, and hematocrit were measured. Hemolysis ratio was calculated with following formula. Hemolysis ratio = (new free hemoglobin production) x (100-hematocrit) / (total hemoglobin). RESULTS: Free hemoglobin production and hemolysis ratio were increased when the suction tip was positioned in the surface than when it was in the middle of the blood. The pressure of negative suction and three kinds of the suction tips did not influence the production of free hemoglobin nor the hemolysis ratio. CONCLUSIONS: The air contact is the most important factor to reduce hemolysis using autologous cell salvage device. Suction pressure or suction tip diameter have little influence to produce hemolysis.

The impact of suctioning RBCs from a simulated operative site on mechanical fragility and hemolysis

BACKGROUND: Intraoperative cell salvage exerts shear stress upon RBCs, particularly as they are suctioned from the surgical field. Shear stress can result in overt hemolysis or it can cause sublethal injury to the suctioned RBCs. The mechanical fragility (MF) test uses shear stress to measure the extent of RBC sublethal injury. RBCs that have sustained sublethal injury are more susceptible to shear stress induced hemolysis. In this study we suctioned whole blood samples from an artificial surgical field to determine if pre-menopausal female RBCs would demonstrate greater resistance to hemolysis and less sublethal injury compared to that of males and post-menopausal females. METHODS: Ten CPD-preserved whole blood units from these 3 donor groups were obtained and samples suctioned at -150 mmHg from a simulated surgical field. The MF test was then performed and the % hemolysis calculated. In addition the MF test was serially performed on these whole blood units during the 21 days of storage. RESULTS: There were no differences in the extent of hemolysis or RBC shear stress resistance after suctioning between the 3 donor groups. During storage the pre-menopausal female RBCs demonstrated higher shear stress tolerance compared to the males or post-menopausal females at all of the time points. CONCLUSION: Although during static storage pre-menopausal female RBCs in CPD-preserved whole blood demonstrated higher shear stress tolerance, this enhanced resistance was not observed after suctioning from a simulated surgical field.