Fragility of Red Blood Cells Collected Under Different Conditions With a Cell Saver Device

Chung, Yoon Sang; Kim, Hye Ryun; Kang, Hyun; Ryu, Choongun; Park, Byungjoon; Hong, Jung-Wan

doi:10.1053/j.jvca.2018.11.019

Cited by 7 publications

(10 citation statements)

References 26 publications

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“…The Cell Saver ® (CS) system is designed for autologous blood salvage with the removal of broken blood cells and platelets, reduction of cytokines and chemokines, and increased hemolysis with an acceptable concentration of cell-free hemoglobin ( Welsby et al, 2021 ). The quality of salvaged RBCs from the CS system after washing, centrifugation, and pump rolling, however, remains unclear, with the fragility of salvaged RBCs might be increased under some conditions ( Chung et al, 2019 ), which could lead to more hemolysis after the salvaged RBCs are transfused back to the patient as osmotic fragility is an important determinant in the severity of hemolysis.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Cell-Saver Caused More Autologous Salvage Hemolysis in a Hereditary Spherocytosis Patient Than in a Normal Erythrocyte Patient

2022

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Hereditary spherocytosis is a common red blood cell disease caused by an inherited red blood cell membrane defect, leading to a spherical shape and propensity for hemolysis. There is a lack of reports on intraoperative autologous blood transfusion for hereditary spherocytosis patients. We hereby report our recent experience with using the Cell Saver® system for intraoperative red blood cell salvage on a hereditary spherocytosis patient. There was a drastic increase in salvaged blood free-hemoglobin compared with the preoperative sample (82.6 mg/dl vs. 6.2 mg/dl) which indicated severe hemolysis. Although our patient recovered smoothly with a normal liver and renal function test and reported no adverse reaction during follow-up, it is noteworthy that severe hemolysis could happen during the cell salvage process for patients with hemolytic anemia, as there are similar reports on sickle cell anemia, beta-thalassemia intermedia, and paroxysmal nocturnal hemoglobinuria. Therefore, more clinical attention and thorough research should be drawn into this perspective, namely, hemolysis during the red blood cell salvage process for patients with hemolytic anemia.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Cell-Saver Caused More Autologous Salvage Hemolysis in a Hereditary Spherocytosis Patient Than in a Normal Erythrocyte Patient

2022

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“…Lactate dehydrogenase (LDH) concentrations were measured using a colorimetric LDH assay kit (ab 102526, Abcam). Mechanical fragility index (MFI) was calculated according to Chung et al 16 Briefly, diluted RBCs were challenged by rocking with stainless steel beads. MFI was calculated from the difference between the levels of fHb in the mechanically stressed RBCs versus control (no beads; no rocking) RBCs; with higher values denoting higher mechanical fragility.…”

Section: Methodsmentioning

confidence: 99%

Effect of modern infusion pumps on RBC quality

et al. 2022

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Background: Mechanical stress on red blood cells is associated with using infusion pumps for blood administration. Current standards in North America leave it to healthcare facilities to consult with manufacturers about infusion pump safety for transfusion; studies on various pumps and red blood cell (RBC) conditions are scarce. Study design and methods: RBC units were pumped through four infusion pumps on d22 (22 days postcollection), d40, d28 after gamma irradiation on d14 (I14d28), and d22 after irradiation on d21 (I21d22). For each experiment, three units were pooled and split among four bags. Samples were collected at gravity and after pumping at clinical nonemergency rates. Hemolysis %, microvesicles, potassium, lactate dehydrogenase, mechanical fragility index levels, and morphology evaluations were performed (n = 5-6).Results: Hemolysis levels of Piston and Linear Peristaltic pump samples were not different from hemolysis of corresponding gravity samples. Peristaltic samples had significantly higher hemolysis compared to gravity, and other pumps, however, maximum mean difference was limited to 0.05%. Pumping at 50 mL/h resulted in the highest hemolysis level. Change in hemolysis % due to pumping was significantly higher in d40 and I21d22 units. No combination of pumps and RBCs conditions led to hemolysis >0.8%. Besides hemolysis, lactate dehydrogenase release was the only marker that demonstrated some differences between infusions via pump versus gravity. Conclusion:The pump design affects the degree of hemolysis. However, for all tested pumps and RBC conditions, this increase was minimal. Hemolysis measurement on d40 and I21d22 at 50 mL/h were concluded to be appropriate parameters for pump evaluation.

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“…33,34 Broadly, it is possible that CS introduces fragile RBCs with sublethal injuries into recipients, which contributes to patients' plasma-free hemoglobin burden. 15 Subsequent binding of PFHb to nitric oxide, a potent regulator of vascular tone and blood pressure, can alter end-organ perfusion and ultimately manifest in perioperative complications. 34,35 While the inference from the data presented here is that overuse of CS could be harmful to patients undergoing ASD surgery, allogenic blood transfusion is not without risk.…”

Section: Deformitymentioning

confidence: 99%

“…Although much of the literature debates the cost efficiency of CS Salvage, another important consideration is its impact on the rheologic properties and oxygen transport capacity of RBCs. High centrifugal loads can reduce RBC elasticity and deformability, increase sublethal RBC injury, reduce RBC 2,3-diphosphoglycerate levels, and compromise washed RBC performance in the microcirculation, potentially obstructing blood flow and compromising tissue oxygenation 14,15 . This single-center retrospective analysis investigates the hypothesis that a greater transfused volume of processed RBCs from CS Salvage is associated with perioperative medical complications and readmissions within 30 days.…”

mentioning

confidence: 99%

High Cell Saver Autotransfusion is Associated with Perioperative Medical Complications in Adult Spinal Deformity Patients

Mohanty

Sardar

Hassan

et al. 2023

Spine

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Study Design. A retrospective, propensity-matched observational study. Objective. To assess the impact of cell saver (CS) homologous transfusion on perioperative medical complications in adult patients undergoing spinal deformity surgery. Summary of Background Data. Despite many endorsing its use, many analyses still refute the efficacy of CS on decreasing total perioperative allogenic red blood cell transfusions, cost efficiency, and its effect on perioperative complications. Methods. Adult patients who underwent spinal deformity surgery at a single center between 2015 and 2021 were retrospectively reviewed. Patient-specific, operative, radiographic, and 30-day complications/readmission data were collected for further analysis. Two methods were utilized to test our hypothesis: (1) absolute threshold model: two cohorts created among patients who received ≥550 mL of CS intraoperatively and those who received less; (2) adjusted ratio model: two cohorts created dependent on the ratio of CS to estimated blood loss (EBL). Propensity-score matching and various statistical tests were utilized to test the association between CS and perioperative medical complications. Results. Two hundred seventy-eight patients were included in this analysis with a mean age of 61.3±15.7yrs and 67.6% being female. Using the first method, 73 patients received ≥550 mL of CS, and 205 received less. Propensity-score matching resulted in 28 pairs of patients. 39.3% of patients with ≥550 mL CS required readmission within 30 days compared with 3.57% of patients in the <550 mL cohort (P=0.016), despite a nearly identical proportion of patients requiring intraoperative blood transfusions (P>0.9999). Using the second method, 155 patients had CS/EBL<0.33 and 123 with CS/EBL ≥0.33. 5.16% and 21.9% among patients with CS/EBL<0.33 and CS/EBL≥0.33, respectively, were readmitted by the 30-day marker (P<0.0001). Conclusions. Our findings indicate that greater CS volumes transfused are associated with higher rates of 30-day readmissions. Thus, surgeons should consider limiting CS volume intraoperatively to 550 mL and when greater volumes are required or preferred, ensuring that the ratio of CS:EBL remains under 0.33.

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Fragility of Red Blood Cells Collected Under Different Conditions With a Cell Saver Device

Cited by 7 publications

References 26 publications

Intraoperative Cell-Saver Caused More Autologous Salvage Hemolysis in a Hereditary Spherocytosis Patient Than in a Normal Erythrocyte Patient

Intraoperative Cell-Saver Caused More Autologous Salvage Hemolysis in a Hereditary Spherocytosis Patient Than in a Normal Erythrocyte Patient

Effect of modern infusion pumps on RBC quality

High Cell Saver Autotransfusion is Associated with Perioperative Medical Complications in Adult Spinal Deformity Patients

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