Cell washing versus immediate reinfusion of intraoperatively shed blood during abdominal aortic aneurysm repair

Long, Graham W.; Glover, John L.; Bendick, Phillip J.; Brown, O. William; Kitzmiller, John W.; Lombness, Patricia; Hanson, Danette

doi:10.1016/s0002-9610(05)81037-2

Cited by 24 publications

(25 citation statements)

References 17 publications

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“…5,17 Coagulopathy may be related to the autotransfusion technique but most often is dilutional following large volume returns. [17][18][19] Only sepsis and disseminated cancer are contraindications, while sickle cell disease is a relative contraindication to the use of autotransfusion. 5 As a result, this device is suitable for use in most abdominal aneurysm repairs.…”

Section: Discussionmentioning

confidence: 99%

Impact of Red Cell Salvage on Transfusion Requirements During Elective Abdominal Aortic Aneurysm Repair

Szalay

Wong

Lindsay

1999

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Impact of Red Cell Salvage on Transfusion Requirements During Elective Abdominal Aortic Aneurysm Repair

Szalay

Wong

Lindsay

1999

Annals of Vascular Surgery

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“…Extended IAT use may also cause a certain degree of hemolysis. While the resultant augmented potassium release is counteracted by the washing process 11 , no cell separator can provide a complete clearance of free hemoglobin, and serum levels may temporarily be elevated 8,14,15,27 . Furthermore, since washed blood does not contain coagulation factors and platelets, massive RBC autotransfusion results in dilutional coagulopathy and a decrease in circulating platelets, requiring administration of the appropriate allogeneic components 6,8,19,28 .…”

Section: Washed Bloodmentioning

confidence: 99%

“…However, the quality of unprocessed blood is inferior with a higher return of lysed cellular debris, platelet microaggregates, fibrin split products, d-dimer, activated complement and free hemoglobin, indicating imbalanced coagulation due to pronounced hemostatic activation and increased hemolysis (Table 1) 6,19,21,27 . In patients systemically anticoagulated for surgical purposes, simple IAT may not be detrimental in smaller amounts 6,19 , but larger quantities may lead to severe hemostatic disturbances with the potential to trigger disseminated intravascular coagulation 6 .…”

Section: Unwashed Bloodmentioning

confidence: 99%

“…IAT has been shown to work efficiently in major orthopedic 9,12,31 , cardiac 32 , urologic 33,34 , vascular 27 , intracranial 35 and gynecological 36 surgery and in emergency procedures, such as spinal trauma 37 . However, because of the wide variety of surgical, patient-related and institutional factors, it is difficult to define specific surgical procedures where IAT should always be used, and the overall blood salvage may not cover more than 25% of all perioperative blood losses 5,12 .…”

Section: Indicationsmentioning

confidence: 99%

“…In patients systemically anticoagulated for surgical purposes, simple IAT may not be detrimental in smaller amounts 6,19 , but larger quantities may lead to severe hemostatic disturbances with the potential to trigger disseminated intravascular coagulation 6 . Because of this limited tolerance to unwashed wound blood, the total amount of retransfusion should clearly be restricted 6,18,21,27 . …”

mentioning

confidence: 99%

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Intraoperative Autotransfusion of RBC and PRP

Gombotz

Kulier

1999

Transfus Alt Transfus Med

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IntraoperativeAutotransfusion of RBC and PRP TATM 1999;3:5-13 • Intraoperative autotransfusion In addition, IP may be used when other autologous whole blood harvesting techniques are not an option. DEPARTMENT OF ANESTHESIOLOGY AND INTENSIVE CARE UNIVERSITY OF GRAZ GRAZ, AUSTRIATransfusion Alternatives in Transfusion Medicine VOLUME 1 NUMBER 3 DECEMBER 1999 Background summaryIntraoperative autotransfusion (IAT) is defined as the reinfusion of patient blood salvaged during and after surgery. IAT plays an important role in the context of perioperative blood saving strategies, having gained standard-of-care status in many surgical procedures 1,6 .The principle of IAT is to collect intraor postoperatively shed blood continuously from the operative field. The salvaged blood is aspirated from the wound site and collected in a dedicated reservoir. Under standard conditions, red cells are subsequently separated, washed, concentrated and stored for later retransfusion to the patient. Only erythrocytes are saved and retransfused; simultaneous volume and plasma replacement has to be provided, especially after processing of large quantities of shed blood 4 .In contrast to stored RBCs, freshly salvaged autologous red cells show uncompromized functional capacity, oxygen delivery to tissues and survival, indicating that IAT has no significant detrimental effects on erythrocytes 7,8 . IAT is most effective when combined with other autologous methods, particularly with preoperative autologous blood donation, acute normovolemic hemodilution or adjuvant drug therapies 4, 9, 10 . Methods Cell separation (washed blood)This technique is based on centrifugation, separating red blood cells (RBCs) from the lighter components and fluids, including plasma, saline and the buffy coat (Cell Saver, Haemolite ® , Haemonetics TM , Braintree, MA; Figure 1). Before starting the procedure, the operator must fill the system with 100-200 mL heparinized saline ("priming"), in order to prevent cells from binding to membrane surfaces initiating microaggregation, and to diminish frictional forces and damage to the cellu- Figure 1lar components 4,8 . Blood released at the wound site is aspirated via a double-lumen suction catheter (80-100 mm Hg), immediately anticoagulated (30,000 IU heparin in 1000 mL saline) at the suction tip, and stored in a plastic cardiotomy reservoir, equipped with a 120 µm microaggregate filter. When a minimum of 1000 mL shed blood is collected, it is pumped into a rotating separation chamber (Latham bowl, 225 mL adaptable capacity), washed with 1000-1500 mL saline and concentrated. Whenever the extent or kind of surgical debris requires more extensive washing, processing cycles can be selected manually, and in emergency cases, washing can be skipped entirely. For pediatric patients, smaller centrifuges are available. As soon as the preset hematocrit is reached, the spinning separator chamber stops, and packed RBCs, suspended in saline solution, are pumped into an infusion bag, while the waste products are removed 4, 11 . Afte...

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Intraoperative and Postoperative Cell Salvage

Hansen

Gombotz

2010

Alternatives to Blood Transfusion in Transfusion Medicine

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Cell washing versus immediate reinfusion of intraoperatively shed blood during abdominal aortic aneurysm repair

Cited by 24 publications

References 17 publications

Impact of Red Cell Salvage on Transfusion Requirements During Elective Abdominal Aortic Aneurysm Repair

Impact of Red Cell Salvage on Transfusion Requirements During Elective Abdominal Aortic Aneurysm Repair

Intraoperative Autotransfusion of RBC and PRP

Intraoperative and Postoperative Cell Salvage

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