Activation of blood coagulation in patients undergoing postoperative blood salvage and re-infusion of unwashed whole blood after total knee arthroplasty

Biagini, Dino; Filippucci, Esmeralda; Agnelli, Giancarlo; Pagliaricci, S.

doi:10.1016/j.thromres.2004.03.006

Cited by 14 publications

(13 citation statements)

References 21 publications

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“…Unwashed salvaged blood contains certain activated coagulation factors as well as fibrinogen degradation products so that its reinfusion could lead to a coagulopathy. In a recent study, Biagini et al 27 found that unwashed salvaged blood reinfusion was associated with an activation of blood coagulation in patients undergoing total knee replacement. The authors concluded that the clinical relevance of this activation has to be tested in prospective studies with adequate sample size.…”

Section: Hemostasismentioning

confidence: 99%

Red cell salvage in orthopedic surgery

Múñoz

Campos

Muñoz

et al. 2006

Transfus Alt Transfus Med

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SUMMARY The increasing number of surgical procedures has raised the demand for allogeneic blood to a level that often exceeds supply. Moreover, 10% of all transfusions are given in the orthopedic surgery setting, requiring the avoidance of liberal transfusion criteria to further reduce the risk of infection and other complications. As a result, a series of blood‐conservation measures have been developed. In this article, we review the use of autologous transfusion in orthopedic surgery, with a special focus on perioperative red cell salvage. From data reviewed, it can be concluded that perioperative salvage of blood, either intraoperative cell salvage or postoperative cell salvage, seems to be an excellent source of functional and viable red cells, without many of the transfusion‐related risks and with few side effects. The effectiveness of perioperative cell salvage to reduce exposure to allogeneic blood is greatly enhanced by the implementation of a restrictive transfusion protocol and the association with other blood‐sparing strategies [preoperative autologous blood donation (PABD), erythropoietin, intravenous iron], especially in anemic patients. Moreover, perioperative cell salvage may reduce the number of required PABD units or render PABD unnecessary. Finally, although formal cost‐effectiveness studies on perioperative cell salvage are lacking, based on current allogeneic blood transfusion costs, it is generally accepted that the equivalent of at least one unit of blood needs to be recovered for these techniques to be cost‐effective. Therefore, these procedures should be used on a case‐by‐case basis.

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Section: Hemostasismentioning

confidence: 99%

Red cell salvage in orthopedic surgery

Múñoz

Campos

Muñoz

et al. 2006

Transfus Alt Transfus Med

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“…Febrile reactions are not uncommon, and hypotension has been reported . These effects are likely mediated by various inflammatory mediators, complement fractions, cytokines and fat particles, all of which are reported to be present . Other theoretical concerns are an increased risk for venous thromboemboli from procoagulants and renal failure from increased levels of free haemoglobin in the shed unwashed blood .…”

Section: Postoperative Autotransfusionmentioning

confidence: 99%

Autologous blood salvage in the era of patient blood management

et al. 2017

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Almost 150 years after the first autologous blood transfusion was reported, intraoperative blood salvage has become an important method of blood conservation. The primary goal of autologous transfusion is to reduce or avoid allogeneic red blood cell transfusion and the associated risks and costs. Autologous salvaged blood does not result in immunological challenge and its consequences, provides a higher quality red blood cell that has not been subjected to the adverse effects of blood storage, and can be more cost-effective than allogeneic blood when used for carefully selected surgical patients. Cardiac, orthopaedic and vascular surgery procedures with large anticipated blood loss can clearly benefit from the use of cell salvage. There are safety concerns in cases with gross bacterial contamination. There are theoretical safety concerns in obstetrical and cancer surgery; however, careful cell washing as well as leucoreduction filters makes for a safer autologous transfusion in these circumstances. Further studies are needed to determine whether oncologic outcomes are impacted by transfusing salvaged blood during cancer surgery. In this new era of patient blood management, where multimodal methods of reducing dependence on allogeneic blood are becoming commonplace, autologous blood salvage remains a valuable tool for perioperative blood conservation. Future studies will be needed to best determine how and when cell salvage should be utilized along with newer blood conservation measures.

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“…[2][3][4] However, the data available concerning the clinical risks and benefits, as well as the laboratory investigations are controversial. 5,6 In particular, USB contains activated coagulation factors and fibrin degradation products that may impair hemostasis when returned to the patient, 7,8 and some authors advocated the need to process the salvaged blood to remove undesirable, procoagulatory material. 5 However, although a long-lasting surgery-induced activation of the procoagulatory and fibrinolytic systems is well established, 9,10 neither long-term follow-up in patients receiving USB nor comparative studies with those receiving ABT have been performed.…”

Section: Introductionmentioning

confidence: 99%

Course of D‐dimer concentrations after total knee replacement surgery: effect of allogeneic and unwashed drainage blood transfusion

Múñoz

García‐Erce²,

Cuenca

et al. 2006

Transfus Alt Transfus Med

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SUMMARY Salvage and return of unwashed filtered shed blood (USB) after unilateral total knee replacement (TKR) is a blood‐saving method frequently used to avoid allogeneic blood transfusion (ABT). However, the use of USB is controversial, as it may impair hemostasis when retransfused. We report on 1‐month follow‐up of fibrinolytic activity in TKR patients who received either ABT, USB or no transfusion. One hundred and six consecutive TKR patients entered the study: 88 received no transfusion (group 1), five received ABT (group 2), and 13 received USB (group 3). Blood samples were obtained on day of surgery and postoperative days 1, 7 and 30, and assayed for blood counts, C‐reactive protein (CRP), and D‐dimers. Demographic and clinical data were also collected. There were no differences in demographic data or postoperative infection rate between groups, but length of hospital stay was longer in group 2 (P < 0.05). Postoperative levels of D‐dimers increased on day 1, and remained elevated on day 30 in all groups, but on day 1 they were higher in group 3 (P < 0.05). There were no differences in perioperative levels of CRP between groups, and they correlated with D‐dimers both preoperatively and on day 30. Taken together, these data suggest that surgery for TKR induced an activation of coagulation and fibrinolysis. This situation lasts at least as late as 30 days after surgery, and is not modified by transfusion, except for a transitory induction of fibrinolysis by USB return in the early postoperative period.

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Activation of blood coagulation in patients undergoing postoperative blood salvage and re-infusion of unwashed whole blood after total knee arthroplasty

Cited by 14 publications

References 21 publications

Red cell salvage in orthopedic surgery

Red cell salvage in orthopedic surgery

Autologous blood salvage in the era of patient blood management

Course of D‐dimer concentrations after total knee replacement surgery: effect of allogeneic and unwashed drainage blood transfusion

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