Autologous transfusion: An alternative to transfusion with banked blood during surgery for cancer

Abstract

Autologous blood transfusion in surgery for cancer has been avoided because of the metastatic potential of reinfused malignant cells. This study determined whether viable tumour cells remain in the red cell concentrate after separation and whether blood transfusion filters remove these tumour cells before reinfusion. Units of banked blood were inoculated with tumour cell lines: breast cancer SKBr3; colon cancer COLO 320; lymphoma Daudi; erythroleukaemia K562. After processing with the Cell Saver, aliquots of the red cell concentrate and waste saline wash were examined for tumour cells and cultured. Tumour cells from all four cell lines were identified in the red cell concentrate but not in the waste saline wash. All the cell lines except Daudi grew from the red cell concentrate. Experiments on two of the cell lines (SKBr3 and COLO 320) were performed in which the red cell concentrate was either unfiltered (control) or filtered with SQ40S blood transfusion filter or RC100 leucocyte depletion filter. Both cell lines were present in the control samples and after filtration with SQ40S filters, and cells from these samples grew normally in culture. No tumour cells were evident after filtration with the RC100 filters and no growth of either cell line was found after 1 week in culture. The Cell Saver in combination with RC100 filters may be suitable for use during the surgical treatment of malignant disease.

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

“…43 Despite acknowledgement of circulating tumour cells in most patients, concern persists regarding transfusion of harvested tumour cells from the operative site, as many studies have established that tumour cells remain in blood after collection and processing using ICS. 36,37,[44][45][46][47][48] Quantification of remaining tumour cells is variable amongst studies, but the literature is in agreement that ICS alone does not effectively remove or destroy tumour cells that have been collected from the operative field. Advanced stage of disease and intraoperative tumour rupture have been identified as risk factors for gross tumour contamination of blood in the surgical field and the subsequent difficulty in removing these cells with ICS processing alone.…”

“…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).…”

“…Furthermore, oncologic cell lines are more robust than primary tumour cells and would be expected to ''outperform'' primary tumour cells through the filtration process, and thus, they are a good test. 45 Using a sensitive polymerase chain reaction (PCR)-based assay and increasing numbers of cells (hepatocellular carcinoma (HCC) cell line), Gwak et al…”

Use of the Cell Saver in Oncologic Surgery

“…[4][5][6][7][8][9][10] The majority of these studies were, for the most part, experimental and conducted using whole blood enriched with culture-derived tumor cells whose properties in terms of adhesiveness, immunity and clonogenicity may differ under actual conditions. Nevertheless, one study conducted on 16 patients operated on for lung cancer detected tumor cells in packed cells by means of simple staining or immunochemical assay in 9 patients (56%).…”

Intraoperative Autotransfusion of RBC and PRP

“…However, clinical evaluations have not found adverse effects of IAT on tumor recurrence or survival 34,41,42 , but no large outcome trials have been completed. The insertion of different leukocyte-depleting filters into the IAT processing loop has been advocated repeatedly to reduce the probability of spreading tumor cells, but results are controversial 34,[43][44][45][46][47][48] . More recently, the irradiation of the erythrocyte suspension retransfusate with 50 Gy has shown promising results 47,48 .…”