Autologous transfusion in acetabuloplasty in children

Abstract

here were 22 patients with cerebral palsy aged six to 17 years who underwent an acetabuloplasty as part of an open reduction of the hip. In 11 patients a paediatric cell saver was used to collect autologous blood which was re-infused per-operatively. This group was compared to a cohort of 11 patients undergoing similar operations in whom only banked homologous blood was transfused.On average, 432 ml of autologous blood was reinfused compared to 909 ml of homologous blood (p < 0.01), representing 19.6% and 47% of the total blood volume, respectively (p < 0.002). Two units of homologous blood were transfused in the cell saver group compared with 20 units in the control group (p < 0.001). When using a paediatric cell saver, homologous blood transfusion was avoided in 82% of patients and there were no complications. Autologous transfusion is well established as an option to deal with loss of blood in orthopaedic procedures. The reduced risk of transmission of diseases, such as hepatitis B and C, AIDS and possibly variant Creutzfeldt-Jakob disease outweighs the increased cost of some forms of autologous transfusion.1-3 Different techniques of autologous transfusion are available; pre-operative donation, peri-operative haemodilution, intra-operative salvage and post-operative collection. To our knowledge no comparative studies on the use of an intra-operative paediatric cell saver have been published. We have compared the transfusion requirements of 11 children who underwent an acetabuloplasty with the use of a cell saver, with those of a cohort of 11 children where a cell saver was not used. Patients and MethodsOver a five-year period, 22 acetabuloplasties were undertaken as part of open reduction of the hip in children with cerebral palsy. In the majority of patients (17), an ipsilateral varus derotation osteotomy of the proximal femur was also carried out. Between 1999 and 2002, we used a paediatric cell saver during the operation in a consecutive series of 11 patients (autologous group). This group was compared with a cohort of 11 consecutive patients operated on between 1997 and 1999, in which a cell saver was not used (control group).To collect and transfuse autologous blood, a BRAT 2® system from COBE® (Quedgeley, UK) was used. The process involves three stages. In the first stage, blood from suction and swabs is collected in a 2 L reservoir and mixed with anticoagulant citrate dextrose formula A. During the second stage the collected blood is centrifuged in a 135 ml bowl, thus concentrating the red blood cells. This concentrate is washed with 1000 to 1500 ml of normal saline to remove cellular stroma, plasma-free haemoglobin, clotting degradation products and anticoagulant. The packed and washed red cells are then pumped into a re-infusion bag. The blood is re-infused through a 20 µm filter at the end of the operation. The autologous blood has a known haematocrit of 60%.We recorded the patients' age, gender, and weight as well as the type and side of the operation. All operations were carried out by the same s...

The Use of Blood Cell Salvage in Acetabular Fracture Internal Fixation Surgery

“…The use of intraoperative blood cell salvage techniques are widespread throughout many areas of orthopaedic surgery, including hip surgery, 6,17-20 scoliosis surgery, 21 knee arthroplasty, 22 pediatric acetabuloplasty, 23 and lumbar fusion surgery. 24 A recent meta-analysis 25 concluded that blood cell salvage in orthopaedic surgery decreases the proportion of patients requiring allogenic blood transfusion perioperatively.…”

Cell Saver: Is it beneficial in scoliosis surgery?

“…McMurray et al [1] and Garvin et al [11] found that Cell Saver decreased the need for donor blood transfusion in primary and revision hip arthroplasty. Cell Saver has also been shown to decrease the amount of other blood transfusions in children undergoing acetabuloplasty [12]. A meta-analysis of the literature on the topic of anesthesia examining the effectiveness of Cell Saver found that its use in orthopedic surgery decreased the need for other transfusions [3].…”

Blood Transfusion-Related Immunomodulation

“…• Lower RBC transfusion in cardiac surgeries [74][75][76] , orthopedic surgeries [77][78][79] , and in liver transplantation 80 ;…”