ABSTRACT
【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.
ABSTRACT
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.
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【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.
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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 .
ABSTRACT
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.