Intraoperative Autologous Transfusion of Hemolyzed Blood

Abstract

During two cases of lumbar spine surgery with instrumentation, we used intraoperative autologous transfusion (IAT), resulting in hemolysis during collection and hemoglobinuria and coagulation abnormalities after transfusion. Hemolysis during IAT collection can lead to hemoglobinuria and binding of nitric oxide, leading to vasoconstriction. The literature suggests that stroma from damaged cells and contact of the blood with the IAT device can lead to coagulation abnormalities and other morbidities, including adult respiratory distress syndrome.

In Vitro Lysis and Acute Transfusion Reactions with Hemolysis Caused by Inappropriate Storage of Canine Red Blood Cell Products

“…30 In another report, 2 separate cases of intraoperative autologous transfusion resulted in delivery of hemolyzed blood. 31 Both patients developed hemoglobinemia and hemoglobinuria, and 1 also developed severe consumptive coagulopathy; both patients survived to discharge.…”

“…In 1 case, 2 units of inadvertently frozen pRBCs were administered to a man with sideroblastic anemia who later developed hemoglobinemia and hemoglobinuria, but did not experience any blood type incompatibility or other adverse reactions 30 . In another report, 2 separate cases of intraoperative autologous transfusion resulted in delivery of hemolyzed blood 31 . Both patients developed hemoglobinemia and hemoglobinuria, and 1 also developed severe consumptive coagulopathy; both patients survived to discharge.…”

“…There are few reports of accidental transfusions of hemolyzed blood in the human literature. 30,31 In 1 case, 2 units of inadvertently frozen pRBCs were administered to a man with sideroblastic anemia who later developed hemoglobinemia and hemoglobinuria, but did not experience any blood type incompatibility or other adverse reactions. 30 In another report, 2 separate cases of intraoperative autologous transfusion resulted in delivery of hemolyzed blood.…”

Suction conditions for minimizing the production of free hemoglobin during blood salvage using an autotransfusion apparatus

“…It is frequently used in children [6] and in patients who refuse transfusion [7], and the cost of this is low [8]. However, postoperative complications have sometimes been reported [9]. The free hemoglobin (Hb) is removed after combining it with haptoglobin or hemopexin [10].…”

Assessment of intra‐operative cell salvage haemolysis in the obstetric and orthopaedic clinical setting, in comparison with allogeneic blood

“…Previous investigations, along with manufacturer's reports, state that between 75 and 95% of free haemoglobin (Hb) is removed by the washing and centrifugation process (Levy et al , ; Valbonesi et al , ; Hansen et al , ; Haemonetics Product Brochure, 2012a,b). However, if the results are above the levels expected, excess free Hb may remain after washing and therefore infusing large volumes of ICS blood may compound comorbidities due to the total load of free Hb (Sloan et al , ).…”