Cell salvage for minimising perioperative allogeneic blood transfusion

Carless, PA; Henry, DA; Moxey, AJ; Dl, O'Connell; Brown, Tamara; Fergusson, DA

doi:10.1002/14651858.cd001888

Cited by 82 publications

(62 citation statements)

References 88 publications

(4 reference statements)

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“…Its use in other adult elective orthopaedic procedures has been shown to reduce the rate of exposure to allogeneic red cell transfusion (RR = 0.42; 95%CI: 0.32-0.54)[7]. In adult spinal surgery, transfusion requirements in both elective surgery and operative fracture fixation are significantly lower when cell salvage is used[1].…”

Section: Discussionmentioning

confidence: 99%

Benefits of the use of blood conservation in scoliosis surgery

Loughenbury

Berry

Brooke

et al. 2016

WJO

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AIMTo investigate whether autologous blood transfusion (ABT) drains and intra-operative cell salvage reduced donor blood transfusion requirements during scoliosis surgery.METHODSRetrospective data collection on transfusion requirements of patients undergoing scoliosis surgery is between January 2006 and March 2010. There were three distinct phases of transfusion practice over this time: Group A received “traditional treatment” with allogeneic red cell transfusion (ARCT) in response to an intra- or post-operative anaemia (Hb < 8 g/dL or a symptomatic anaemia); Group B received intra-operative cell salvage in addition to “traditional treatment”. In group C, ABT wound drains were used together with both intra-operative cell salvage and “traditional treatment”.RESULTSData from 97 procedures on 77 patients, there was no difference in mean preoperative haemoglobin levels between the groups (A: 13.1 g/dL; B: 13.49 g/dL; C: 13.66 g/dL). Allogeneic red cell transfusion was required for 22 of the 37 procedures (59%) in group A, 17 of 30 (57%) in group B and 16 of 30 (53%) in group C. There was an overall 6% reduction in the proportion of patients requiring an ARCT between groups A and C but this was not statistically significant (χ2 = 0.398). Patients in group C received fewer units (mean 2.19) than group B (mean 2.94) (P = 0.984) and significantly fewer than those in group A (mean 3.82) (P = 0.0322). Mean length of inpatient stay was lower in group C (8.65 d) than in groups B (12.83) or A (12.62).CONCLUSIONWhen used alongside measures to minimise blood loss during surgery, ABT drains and intra-operative cell salvage leads to a reduced need for donor blood transfusion in patients undergoing scoliosis surgery.

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Section: Discussionmentioning

confidence: 99%

Benefits of the use of blood conservation in scoliosis surgery

Loughenbury

Berry

Brooke

et al. 2016

WJO

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“…Previous meta-analyses12202444 have investigated the efficacy and safety of cell salvage in THA. However, the strength of these meta-analyses was weakened by poor methodological quality or other limitations, and the conclusions were inconsistent.…”

Section: Discussionmentioning

confidence: 99%

“…Autologous blood transfusion, including preoperative autologous blood donation, intraoperative blood salvage and postoperative autotransfusion drain (PATD), is considered effective in reducing allogenic blood transfusion and its underlying risks91213. In several autologous transfusions, PATD is considered relatively simple to implement and potentially cost-effective1415.…”

mentioning

confidence: 99%

Postoperative autotransfusion drain after total hip arthroplasty: a meta-analysis of randomized controlled trials

Xie

Pan

Hong

et al. 2016

Sci Rep

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The use of a postoperative autotransfusion drain (PATD) to reduce allogenic blood transfusions in total hip arthroplasty (THA) remains controversial. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of this technique. Randomized controlled trials (RCTs) were identified from PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Thirteen RCTs (1,424 participants) were included in our meta-analysis. The results showed that PATD reduced the rate of allogenic transfusions (RR = 0.56; 95% CI [0.40, 0.77]) and total blood loss (MD = −196.04; 95% CI [−311.01, −81.07]). Haemoglobin (Hb) levels were higher in the PATD group on postoperative day 1 (MD = 0.28; 95% CI [0.06, 0.49]), but no significant differences on postoperative days 2 or 3 (MD = 0.29; 95% CI [−0.02, 0.60]; MD = 0.26; 95% CI [−0.04, 0.56]; respectively). There were no differences in length of hospital stay (MD = −0.18; 95% CI [−0.61, 0.25]), febrile reaction (RR = 1.26; 95% CI [0.95, 1.67]), infection (RR = 0.95; 95% CI [0.54, 1.65]), wound problems (RR = 1.07; 95% CI [0.87, 1.33]), or serious adverse events (RR = 0.59; 95% CI [0.10, 3.58]). Our findings suggest that PATD is effective in reducing the rate of allogenic transfusion. However, the included studies are inadequately powered to conclusively determine the safety of this technique.

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“…Concerns over unwashed blood include low Hb concentration, and the presence of anticoagulant and inflammatory mediators in the reinfused blood. Both washed and unwashed blood results in a hypocoagulable state, although less so with washed blood,77 but no difference in clinical outcomes has been identified 75…”

Section: Intraoperativementioning

confidence: 99%

Blood management in total knee arthroplasty: state-of-the-art review

et al. 2018

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Total blood loss from primary total knee arthroplasty may exceed 2 L with greater blood loss during revision procedures. Blood loss and allogeneic transfusion are strongly associated with adverse outcomes from surgery including postoperative mortality, thromboembolic events and infection. Strategies to reduce blood loss and transfusion rates improve patient outcomes and reduce healthcare costs. Interventions are employed preoperatively, intraoperatively and postoperatively. The strongest predictor for allogeneic blood transfusion is preoperative anaemia. Over 35% of patients are anaemic when scheduled for primary and revision knee arthroplasty, defined as haemoglobin <130 g/L for men and women, and the majority of cases are secondary to iron deficiency. Early identification and treatment of anaemia can reduce postoperative transfusions and complications. Anticoagulation must be carefully managed perioperatively to balance the risk of thromboembolic event versus the risk of haemorrhage. Intraoperatively, tranexamic acid reduces blood loss and is recommended for all knee arthroplasty surgery; however, the optimal route, dose or timing of administration remains uncertain. Cell salvage is a valuable adjunct to surgery with significant expected blood loss, such as revision knee arthroplasty. Autologous blood donation is not recommended in routine care, sealants may be beneficial in select cases but further evidence of benefit is required, and the use of a tourniquet remains at the discretion of the surgeon. Postoperatively, restrictive transfusion protocols should be followed with a transfusion threshold haemoglobin of 70 g/L, except in the presence of acute coronary syndrome. Recent studies report no allogeneic transfusions after primary knee arthroplasty surgery after employing blood conservation strategies. The current challenge is to select and integrate different blood conserving interventions to deliver an optimal patient pathway with a multidisciplinary approach.

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Cell salvage for minimising perioperative allogeneic blood transfusion

Cited by 82 publications

References 88 publications

Benefits of the use of blood conservation in scoliosis surgery

Benefits of the use of blood conservation in scoliosis surgery

Postoperative autotransfusion drain after total hip arthroplasty: a meta-analysis of randomized controlled trials

Blood management in total knee arthroplasty: state-of-the-art review

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