A new approach for fat removal in a discontinuous autotransfusion device–concept and evaluation

Abstract

Background Fat present during blood salvage in orthopaedic or cardiac surgery can pose a risk of fat embolism and should be eliminated before transfusion. Based on observations of central fat accumulation at the bottom of Latham bowls, a fat reduction program was developed using two volume displacements, where blood temporarily is removed and respun in the bowl to force the fat through the RBC sediment. Materials and MethodsPooled ABO-matched RBC and FFP were adjusted to a haematocrit of 10%, and human fat tissue added to a concentration of 1Á25 vol%. In six experiments, blood was processed with the new-generation cell salvage device CS Elite in a newly developed fat reduction program in bowls of three sizes. Volumetric quantification of fat was performed after centrifugation of blood samples in Pasteur pipettes. From volumes, haematocrits and the concentrations of fat, RBC recovery and fat elimination rates were calculated.Results Fat removal rates of 93Á2 -2Á8, 97Á0 -2Á1 and 99Á6 -0Á3% were observed with a 70-ml, 125-ml and 225-ml bowl, respectively, and even higher rates when removal rates were calculated one cycle. At the same time, high RBC recovery and plasma elimination rates were maintained, not significantly different to the default program mode.Conclusion Modifications in process parameters and sequence led to a fat reduction program that significantly improves fat removal with the Cell Saver Elite from 77Á4 -5Á1% in the default mode to an average of 98Á6 -1Á1%, yielding results equivalent to the continuous cell salvage system (C.A.T.S).

PRISM: A Novel Human Islet Isolation Technique

“…A key feature of the PRISM technique is a continuous flow centrifugation bowl, in which digested tissue is retained, washed, and purified. Research in the field of interoperative blood salvage has shown that continuous flow centrifuge bowls are able to very effectively wash out fat, 38 cytokines, 39 and ions, 40 when appropriate centrifuge and pump speeds are used. Only 1 cycle (volume of the bowl) is needed to achieve this result.…”

“…Only 1 cycle (volume of the bowl) is needed to achieve this result. 40 PRISM uses 7 L of liquid to wash out digestive enzymes and cell debris while collecting the digested tissue in the centrifuge bowl. Prior studies have also shown that purification of viable leukocytes can be performed using a continuous flow centrifuge bowl from whole blood or marrow.…”

Combined Platelet and Red Blood Cell Recovery during On-pump Cardiac Surgery Using same™ by i-SEP Autotransfusion Device: A First-in-human Noncomparative Study (i-TRANSEP Study)

“…16,20,23,[27][28][29] Further, we demonstrated a high removal of triglyceride with the standard program, in line with data obtained using centrifugation. 30,31 Free hemoglobin removal, while difficult to evaluate because hemolysis might occur after processing the blood, was high and comparable to centrifugation-based devices. 20,21 Even though posttreatment free hemoglobin concentration was higher than previously reported in the preclinical study, 16 it remained below the recommended threshold of 500 to 1,000 mg/dl according to the Association for the Advancement of Blood & Biotherapies (Bethesda, Maryland) guidelines.…”

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

“…Various dynamic recovery sizes are available to suit the speed and magnitude of the bleed. There are also variances in centrifugation speed, washing method, haematocrit sensitivity and priming [6,7,[19][20][21][22]. The selection of the device shall be made according to the needs by evaluating the differential characteristics of each application, as outlined in Figure 1.…”