Use of a leucocyte filter to remove tumour cells from intra‐operative cell salvage blood

Abstract

SummaryThe intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2 ⁄ 50 central venous samples, 34 ⁄ 50 reservoir samples and 31 ⁄ 50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.

From Bloodless Surgery to Patient Blood Management

“…41,56 -60 Notably, several studies have indicated that leukocyte depletion filters are able to substantially reduce and remove unwanted cells and particulate materials from the salvaged blood. 61,62 Overall, intraoperative cell salvage remains a safe and effective technique in reducing allogeneic transfusions and improving patient outcomes. 17,53 On the other hand, acute normovolemic hemodilution relies on removing a part of the blood volume from the circulation and replacing it with other fluids (crystalloids or colloids) before bleeding takes place.…”

Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score–matched case–control analysis

“…A third-generation leukocyte depletion filter (Imugard III-RC [Terumo]) was routinely used for autologous transfusion of cell-salvaged blood. 13,19,32 Cell salvage was stopped when the tumour capsule was exposed during parenchymal transection, and a standard aspiration device was used further to minimize shedding of tumour cell into the cell saver reservoir. 19 Cell salvage was used only during liver resection and not for extrahepatic procedures.…”

Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy?

“…These are ex vivo studies using oncologic cell lines that are seeded in banked or fresh blood 45,[51][52][53][54][55][56] or primary tumour cells collected at the time of tumour resection 48,49,[57][58][59] and then processed via ICS and subsequent LR filtration. Together, these studies show that advanced generation LR filters are very effective in the removal of tumour cells after ICS processing (the results of experiments where tumour cells were NOT completely removed are recorded in bold print in Table 1).…”