BackgroundCell salvage in obstetrics is still a controversial subject and has yet to be fully embraced. The aim of this exploratory study was to measure amniotic fluid (AF), heparin, and fetal red cell contamination of washed filtered salvaged maternal blood and to investigate differences based on the number of suction devices used.MethodsPatients undergoing elective Caesarean section were assigned alternately to one of two groups. In Group 1, all blood and AF was collected with one suction. In Group 2, AF was aspirated to waste with a second separate suction device before collection of any blood.ResultsIn both groups, alpha-fetoprotein (AFP), squames cells, and heparin were significantly reduced (P<0.001) by the washing and filtering process. Mean AFP levels post-filtration were 2.58 IU ml−1 in Group 1 and 3.53 IU ml−1 in Group 2. Squames cells were completely removed in all but two cases. Fetal red blood cells were still present in the final product, range 0.13–4.35%. In Group 1, haemoglobin and haematocrit were higher than in Group 2, with lower white blood cell, AFP, and fetal red cell counts.ConclusionsThis study adds to the growing body of evidence that there is little or no possibility for AF contamination to enter the re-infusion system when used in conjunction with a leucodepletion filter.
The implementation of a blood conservation strategy which includes the use of intraoperative cell salvage appears safe and can contribute to a reduction in the number of blood transfusions to the obstetric population. We remain uncertain of the significance of fetal red cell contamination.
We have shown that the LDH and Haemolysis Index tests are suitable and reliable alternatives for measuring haemolysis from samples obtained from ICS or allogeneic blood. We have incorporated the LDH test into our Hospital's ICS QC package and recommend that this test is considered for all ICS QC samples.
Summary
Objective
To assess the value of patient blood management (PBM) in the detection and management of preoperative anaemia before elective surgery.
Background
PBM is recognised as the standard of care, with diagnosis and management of preoperative anaemia being the key components of PBM. No formal assessment of the value of PBM anaemia screening and correction before scheduled surgery had been made at our hospital.
Methods
We conducted a retrospective study in a tertiary‐care, academic hospital of consecutive records of elective surgery (n = 25 641). We excluded minor surgeries. We identified anaemic patients who had been assessed by PBM or not (non‐PBM). We calculated transfusion incidence and hospital length of stay (LOS) across all surgical specialities.
Results
During the 1‐year study period, 15 245 patients were eligible for inclusion; 311 patients (2·0%) were transfused, and 83·3% of transfusions were in anaemic patients. Transfusion incidence was 9·2% in anaemic PBM‐assessed patients and 17·4% in non‐PBM patients. For haemoglobin (Hb) <100 g L−1, the transfusion incidence was 22·1% [95% confidence interval (CI) 15·5–30·6%] in PBM and 40·0% (95% CI 35·1–45·0%) in non‐PBM patients, and for Hb 100–119 g L−1, it was 4·7% (95% CI 2·8–7·5%) and 7·9% (95% CI 6·3–9·8%), respectively. Overall mean LOS was 2·1 days [standard deviation (SD) 6·0]. Mean LOS with Hb <100 g L−1 was 6·7 days (SD 14·8) in PBM‐assessed patients and 12·4 days (SD 19·5) in non‐PBM patients and was 3·1 (SD 5·2) and 6·2 (SD 9·5) days, respectively, for Hb 100–119 g L−1.
Conclusion
Anaemic elective surgery patients assessed by patient blood management (PBM) had a markedly lower transfusion risk and shorter LOS than anaemic patients not assessed by PBM.
ICS involving skimming collection techniques (orthopaedics) had significantly more haemolysis than pooled collections (obstetrics) (P < 0·001). Further analysis of orthopaedic data highlighted a difference between the three machines used with the Haemonetics OrthoPat (Haemonetics Ltd., Watford, UK) significantly higher with a free Hb of 29·8 g L(-1) compared with the other two machines 6·7 g L(-1) (P < 0·001). On comparison of ICS blood to allogeneic blood, free Hb levels obtained from ICS were significantly higher (P < 0·001).
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