Coagulopathy associated with cell salvage transfusionfollowing cerebrovascular surgery

Abstract

A 35-year-old man was scheduled for dural arteriovenous fistula resection for vascular malformation under general anesthesia and a cell saver device was employed. The patient suffered from massive bleeding for the rupture of arteriovenous malformations from the beginning of the operation and 1000 mL cell-saved blood was transfused. After autologous blood transfusion and fluid resuscitation, blood oozed significantly from the surgical wounds, and the administration of cryoprecipitate and fibrinogen has no effect. The value of the activated coagulation time (ACT) increased to 999s. Considering the residual heparin in the autologous blood, ninety mg of protamine was intravenously injected, then 5 minutes later the ACT dropped to 147s. After the therapy, the surgical procedure was performed smoothly. The activated partial thromboplastin time (APTT) and the thrombin time (TT) of the postoperative venous blood was 18.9 s and 53.6 s respectively. Two days later, the APTT and the TT decreased to 12.1 s and 32.7 s without special treatment. The patient was discharged home without complications and well follow-up.

Impact of intra-operative cell salvage on blood coagulation in high-bleeding-risk patients undergoing cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial

“…Clinicians would have to use protamine to reverse the residual heparin according to the ACT value. The value of ACT may be prolonged by hemodilution which is very common in this kind of surgery [ 22 ]. Thus, ACT is a partially reliable bedside method for monitoring the adequacy of anticoagulation.…”

“…In our study, although the concentration 25,000 IU/L and the degree of washing 5:1 volume ratio between the 0.9 % saline wash and blood were used, the incidence of heparin residual at the end of surgery in Group CS was up to 15.09 %. This implies that the concentration of 25,000 IU/L may be still risky [ 22 ]. The solution to this specific problem may be either reducing the concentration of anticoagulant heparin saline or administering an appropriate dose of protamine to reverse heparin depends on the monitoring of TEG.…”

Multidisciplinary paper on patient blood management in cardiothoracic surgery in the UK: perspectives on practice during COVID-19

“…In addition, blood loss can never be predicted. Cell salvage is however not entirely without problems: removing platelets and haemostatic blood factors especially if a large volume of blood is processed, might increase the risk of post-operative bleeding and the requirement for allogenic blood products [ 41 ]. Cell salvage remains an essential tool in cardiac surgery and is even more relevant in the COVID-19 pandemic due to the challenge for blood availability and supply.…”