Intraoperative blood salvage may shorten the lifespan of red blood cells within 3 days postoperatively

Abstract

Background:Intraoperative blood salvage (IBS) recovers most lost blood, and is widely used in the clinic. It is unclear why IBS does not reduce long-term postoperative requirements for red blood cells (RBCs), and 1 possibility is that IBS affects RBC lifespan.Methods:Prospectively enrolled patients who underwent spine, pelvic, or femur surgery not involving allogeneic RBC transfusion were grouped based on whether they received IBS or not. Volumes of blood lost and of RBCs salvaged during surgery were recorded. Total blood cell counts, levels of plasma-free hemoglobin, and CD235a-positive granulocytes were determined perioperatively.Results:Although intraoperative blood loss was higher in the IBS group (n = 45) than in the non-IBS group (n = 52) (P < .001), hemoglobin levels were similar between groups (P = .125) at the end of surgery. Hemoglobin levels increased in non-IBS patients (4 ± 11 g/L), but decreased in IBS patients (−7 ± 12 g/L) over the first 3 postoperative days. Nadir hemoglobin levels after surgery were higher in the non-IBS group (107 ± 12 g/L) than in the IBS group (91 ± 12 g/L). Salvaged RBC volume correlated with hemoglobin decrease (r = 0.422, P = .004). In multivariate analysis, salvaged RBC volume was an independent risk factor for hemoglobin decrease (adjusted odds ratio 1.002, 95% confidence interval 1.001–1.004, P = .008). Flow cytometry showed the numbers of CD235a-positive granulocytes after surgery to be higher in the IBS group than in the non-IBS group (P < .05).Conclusion:IBS may shorten the lifespan of RBCs by triggering their engulfment upon re-infusion (China Clinical Trial Registry ChiCTR-OCH-14005140).

Coagulopathy complicating intraoperative blood salvage in patients receiving cesarean section: three case reports and a literature review

“…On the other hand, we also know that the amount of PPH (postpartum hemorrhage) is usually estimated to be less than the actual amount, and there is also a possibility that we made an inadequate estimation of bleeding volume; however, the vital signs were stable in these 3 cases after surgery, and the urine output in these three cases was appropriate. There may be another explanation for the fact that the estimated blood loss seems inadequate; during the ICS, blood cells might be damaged, the loss of blood cells might exist, and the total amount of blood collected may be less than expected [8]. We are inclined to consider the possible cause of these three cases to be dilutional coagulopathy.…”

The Effect of Cell Salvage on Bleeding and Transfusion Needs in Cardiac Surgery

“…The difference in mean postoperative hemoglobin concentrations at 24 h and in its lowest postoperative values of only 0.5 g/dL in favor of the cell-salvage group patients could be attributed to the relatively low concentration effect, with an Hct of approximately 42% vs. Hct > 50% that is reported in the manufacturers' datasheet [ 11 ]. This, together with a shortened lifespan of salvaged RBCs [ 12 , 13 ], might have mutually contributed to comparable transfusions of RBCs between the groups.…”

“…is, together with a shortened lifespan of salvaged RBCs [12,13], might have mutually contributed to comparable transfusions of RBCs between the groups.…”

Cost-Effectiveness of Cell Salvage in Trauma Blood Transfusions

“…Another concern is that the centrifugation part of the CS process can damage red blood cells, shortening their lifespan. 13 Several reviews have measured the outcomes of patients receiving CS, but few have analyzed its effectiveness specifically in trauma patients. 10,14,15 Furthermore, additional studies analyzing clinical outcomes have been published since the last systematic review that focused on trauma patients.…”