Proposal for Internal Quality Management in Intra- and Postoperative Blood Salvage

Hansen, Ernil; Altmeppen, J.

doi:10.1159/000064232

Cited by 12 publications

(30 citation statements)

References 10 publications

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“…This is also true for the proposals concerning QM in IBS [1,4]. In this regard, it is of note that the frHb elimination rate always is significantly lower than the protein elimination rate [5][6][7] (e.g.…”

Section: Free Hemoglobinmentioning

confidence: 89%

“…RBC recovery can be calculated from the volumes and the HCT values in the processed wound blood (sample from reservoir) and in the produced RBC concentrate (sample from transfusion bag). The plasma elimination rate is derived from the respective supernatant volumes and concentrations of an indicator such as total protein, albumin, free hemoglobin (frHb), or potassium ions [1]. Alternatively, assessment of the frHb residual contamination of the product is discussed.…”

Section: Quality Assurance In Intraoperative Blood Salvagementioning

confidence: 99%

“…The RBC concentrates in additive solution generally used contain almost no plasma; thus density (ρf) and viscosity (ηf) of the medium is significantly reduced compared to plasma. Consequently, 4 of the 5 parameters in Stoke's law of sedimentation dp 2 × (ρp-ρf) vs= × a 18 × ηf (1) are affected. It is therefore clear that the behavior of these RBCs during centrifugation and cell separation and washing can hardly represent salvaged wound blood.…”

Section: Experimental Testing Of Devices and Process Variablesmentioning

confidence: 99%

“…A proposal for such a QM system has been worked out and published [1]. In the following, the implementation of these concepts and their performance in clinical practice are described.…”

Section: Introductionmentioning

confidence: 99%

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Quality Management in Blood Salvage: Implementation of Quality Assurance and Variables Affecting Product Quality

Hansen¹,

Bechmann²,

Altmeppen³

et al. 2004

Transfus Med Hemother

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Implementation of quality management in intraoperative blood salvage with controls of product and process quality supports early recognition and repair of dysfunction if respective actions are laid down in the quality management handbook. In order to avoid insufficient quality and to improve process quality, a broad understanding of the processes and of the variables affecting quality is needed, which is based on experimental tests. For this purpose the use of fresh whole blood as test blood and of protein as parameter for determination of the plasma elimination rate is favorable over outdated banked blood and free hemoglobin. Tested this way, the process of blood collection by suction is by far not as harmful to RBCs as expected. Partially filled bowls, lower wash volumes, or a fastened filling or washing should be avoided. Plasma washout can be improved by higher wash volumes or by slower filling and washing, which avoids increased loss of RBCs. Quality management which is based on a better understanding of the procedure as well as quality controls can help to supply high-quality blood for optimal hemotherapy by blood salvage.

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Section: Free Hemoglobinmentioning

confidence: 89%

Section: Quality Assurance In Intraoperative Blood Salvagementioning

confidence: 99%

Section: Experimental Testing Of Devices and Process Variablesmentioning

confidence: 99%

“…A proposal for such a QM system has been worked out and published [1]. In the following, the implementation of these concepts and their performance in clinical practice are described.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Quality Management in Blood Salvage: Implementation of Quality Assurance and Variables Affecting Product Quality

Hansen¹,

Bechmann²,

Altmeppen³

et al. 2004

Transfus Med Hemother

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“…Accordingly, a proposal for a QM system in intra-and postoperative autotransfusion has been put forward. 1 It states that QM is not possible with unwashed blood, since quality cannot be assessed nor controlled.…”

Section: There Is No Safety In Low Volumementioning

confidence: 99%

Pro and Con Discussion: Retransfusion of Unwashed Blood

Vagianos

Hansen

2004

Transfus Alt Transfus Med

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Autotransfusion of unprocessed blood (AUB), either intra-or postoperatively, represents the oldest and simplest method for own blood retransfusion. It includes collection by aspiration of blood from the surgical field, or from postoperative drains, in cardiothoracic and orthopedic operations, simple filtration of this blood and retransfusion, as opposed to processing the shed blood by centrifugation, applying more modern systems, and retransfusing washed red blood cells.During AUB, blood is collected by using low suction, is passed through filters with micropores with a diameter less than 170 µm and is anticoagulated by using citric acid as an anticoagulant, at a rate of 1/7 to the collected blood. Anticoagulation is not required when blood is collected from cavities where prior fibrinolysis has taken place, as in cases of postoperative autotransfusion. After collection the blood is reinfused by using gravity, being filtered again through 40 µm pore filters.

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Ergebnisqualität bei der Maschinellen Autotransfusion und Einflussfaktoren

Hansen¹,

Bechmann²,

Altmeppen³

et al. 2004

Anasthesiol Intensivmed Notfal

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Also intraoperative blood salvage (IBS) requires a system for quality management with controls of product an process quality. These can help early detection of malfunctions. For proper reaction and for improvement of quality a deep understanding of the process of blood salvage is necessary. This is supported by experimental testing of equipment, programs, and process variables, and by analysis of their effects on the process. The use of fresh whole blood and total protein as wash-out parameter in these tests is superior to outdated banked RBC and free haemoglobin. The process of aspiration turns out much less harmful than expected, when tested with fresh blood. Low wash volumes, fast washing rates, and half full bowls should be avoided. Plasma wash-out is improved by slower washing or by higher wash volumes, but the latter decrease RBC recovery. Such quality management helps to provide blood of excellent quality by IBS for optimal haemotherapy.

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Proposal for Internal Quality Management in Intra- and Postoperative Blood Salvage

Cited by 12 publications

References 10 publications

Quality Management in Blood Salvage: Implementation of Quality Assurance and Variables Affecting Product Quality

Quality Management in Blood Salvage: Implementation of Quality Assurance and Variables Affecting Product Quality

Pro and Con Discussion: Retransfusion of Unwashed Blood

Ergebnisqualität bei der Maschinellen Autotransfusion und Einflussfaktoren

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