Quick biochemical markers for assessment of quality control of intraoperative cell salvage: a prospective observational study

Abstract

BackgroundIntraoperative Cell Salvage (ICS), hereby referred to ‘mechanical red cell salvage’, has been widely used in adult elective major surgeries to reduce requirement for homologous red blood cell transfusion and its associated complications. However, amount of free haemoglobin (fHb) from ICS has been shown related to incidence of renal failure. fHb is the most important indicator of quality control of cell salvaged blood, thus monitoring the fHb concentration is imperative to minimise renal injury. However, currently there has been lacking quick biochemical markers to monitor the levels of fHb during ICS. The aim of this study was to screen quick biochemical markers for evaluating the amount of fHb during use of intraoperative cell salvage.MethodsTwenty patients undergoing elective cardiovascular surgery were enrolled. Blood was collected and processed using a Fresenius continuous auto-transfusion system device. The concentration of fHb, albumin (Alb), and calcium (Ca) in three washing modes were measured, and their clearance rates were calculated. The correlations among the clearances and concentrations of fHb, albumin, and calcium were analysed.ResultsIn three washing modes, concentrations of albumin and calcium are significantly associated with amount of fHb:fHb(g/L) = 0.111Alb(g/L) –0.108, R = 0.638, p = 0.000; fHb(g/L) = 1.721Ca(mmol/L) +0.091, R = 0.514, p = 0.000. Furthermore, the clearance rates of albumin and calcium significantly predict clearance of fHb, CRfHb = 0.310CRALB + 0.686, R = 0.753, p = 0.000, CRfHb = 0.073 CR Ca + 0.913, R = 0.497, p = 0.000.ConclusionsIn clinic practice, clearance rates of albumin, or calcium can be used to evaluate the quality of salvaged blood, fHb. Bed-side measurement of calcium could offer a more feasible means for clinicians to undertake a real-time assessment of fHb.

Effects of transfusion load and suction pressure on renal function in intraoperative salvage autotransfusion

“…Although the long-term immune shifting effect still needs further detailed analysis, intraoperative salvage autotransfusion might be a safe option in the immune context. In addition to renal function, the influence of intraoperative salvage autotransfusion on proinflammatory cytokines, platelet activation, coagulation, fibrinolysis, and hemolysis factors should also be considered in clinical practice, as reported ( 10 , 30 , 31 ), which will be analyzed in a future clinical study. All of these indicate that in addition to the more detailed evaluation of renal function by glomerular filtration rate and blood urea nitrogen, immune function change induced by intraoperative salvage autotransfusion should also be studied.…”

Evaluation of riboflavin photochemical treatment for inactivation of HCT116 tumor cells mixed in simulative intraoperative salvage blood

“…Therefore, it is also feasible to use RPT technology to deal with the blood salvaged from patients with malignant tumors during operation and inactivate the tumor cells. Different from the normal anticoagulant whole blood extracted from the vein, the blood salvaged from the operative field experienced a continuous nonphysiologic process including primary coagulation activation, negative vacuum suction, filtration, washing, and resuspension, and RBCs have suffered a certain degree of mechanical damage . It remains unclear whether salvaged RBCs can tolerate the superimposed damage caused by RPT.…”

“…In recent years, with the rapid development of IBS technology, it has been widely used in cardiac surgery, vascular surgery, orthopedics, general surgery, obstetrics and gynecology, neurosurgery, urology, and pediatric surgery. IBS significantly reduces the amount of allogeneic blood transfusion, greatly decreases the risk and complications of transfusion, and saves a number of blood resources . However, due to concerns that malignant tumor cells fall off during the operation and pollute the salvaged blood, leading to the distant spread of the tumor through blood circulation, tumor surgery has been a relatively restricted area of IBS for many years …”

Evaluation of acute normovolemic hemodilution in patients undergoing intracranial meningioma resection

“…As some studies previously reported, [ 11 , 12 ] Jingjing 3000P device was used for ICS procedure in this study. The standard operative procedures were performed according to the manufacturer's recommended protocols.…”