Cell saver processing mitigates the negative effects of wound blood on platelet function

Gäbel, Jakob; Malm, Carl Johan; Radulovic, Vladimir; Hakimi, Caroline Shams; Westerberg, Martin; Jeppsson, Anders

doi:10.1111/aas.12730

Cited by 9 publications

(10 citation statements)

References 20 publications

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“…No entanto, a maior parte dos estudos defende que não há alterações no sistema de coagulação [28,30,33] ou aumento de sangramento [24]. O estudo desenvolvido por Gabel et al (2016) verificou que a sucção da máquina de CEC causa uma diminuição da função plaquetária e que o processo de RIC elimina estes efeitos negativos, de modo a não prejudicar a coagulação do paciente. Desta forma, ainda são necessários mais estudos para verificar se há alterações de coagulação e se os possíveis problemas estão correlacionados a RIC ou a sucção realizada previamente [35].…”

Section: Resultsunclassified

Diminuição Do Uso De Bolsas De Sangue Em Cirurgias Cardiovasculares Pelo Uso Da Recuperação Intraoperatória De Células

Chaves

Cardoso

Rocha

2018

R. Bras. Inov. Tecnol. Saúde

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Cirurgias cardíacas são procedimentos complexos onde há grande perda sanguínea e consequentemente é necessário repor o volume perdido. O uso de bolsas de sangue em cirurgias cardíacas é rotina em hospitais. Entretanto, há grandes problemas relacionados à falta de hemocomponentes devido a sua ampla demanda em várias áreas médicas e ao estoque pequeno mantido em hemocentros e a pouca quantidade de doadores disponíveis. Outros problemas relacionados à transfusão de sangue são as complicações pós-operatórias causadas e a não aceitação desse procedimento por grupos religiosos como os Testemunha de Jeová. Desta forma, a recuperação intraoperatória de células (RIC) pode ser uma alternativa ao uso de hemocomponentes. O presente trabalho objetivou verificar por meio de revisão bibliográfica a partir de 2006 se a autotransfusão durante cirurgias cardíacas através da recuperadora de células é eficaz na redução do uso de bolsas de sangue. Além disso, buscou-se averiguar quais as consequências da técnica no sistema de coagulação e sua viabilidade clínica. Verificou-se que grande parte dos estudos concorda que o uso da RIC diminui a necessidade de bolsas de concentrado de hemácias (CH) durante cirurgias cardíacas. No entanto, há contradições a respeito da diminuição total de hemoconcetrados, das complicações pós-operatórias, dos efeitos da técnica na ação plaquetária e da viabilidade do método. Logo, os estudos sobre a viabilidade do método são inconclusivos, sendo necessários novos estudos com metodologias melhoradas para avaliar mais fielmente a técnica. Também é necessário padronizar as variáveis possíveis para obter melhores resultados.

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Section: Resultsunclassified

Diminuição Do Uso De Bolsas De Sangue Em Cirurgias Cardiovasculares Pelo Uso Da Recuperação Intraoperatória De Células

Chaves

Cardoso

Rocha

2018

R. Bras. Inov. Tecnol. Saúde

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“…Ovrum et al 24 verified the safety of the method in a series of close to 6,000 patients. Thrombotic events related to retransfusion of pericardial blood 11,28 are avoided by cell salvage. The remaining foreign surface interface mimics the situation during extracorporeal membrane oxygenation (ECMO), 15 where the experience of low-heparinisation protocols is extensive.…”

Section: Discussionmentioning

confidence: 99%

“…10 The use of cell salvage represents one alternative to diminish the negative interference of proinflammatory components, with possible favourable effects on platelet function. 11,12 Heparin-coated CPB circuits combined with lowdose systemic heparin have a 30-year history. 13 The ameliorating effects on systemic inflammatory responses, transfusion rates and perioperative bleeding are well documented.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to minimise transfusions and blood loss

et al. 2019

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Background: Patients with preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion. We hypothesise that an optimised cardiopulmonary bypass strategy reduces postoperative blood loss and transfusions. Methods: In total, 60 patients admitted for coronary artery bypass grafting with ticagrelor and aspirin medication withdrawn <96 hours before surgery were prospectively randomised into two equal sized groups. Cardiopulmonary bypass combined a closed Cortiva® heparin-coated circuit with low systemic heparinisation (activated clotting time < 250 seconds) and intraoperative cell salvage in the study group, whereas the control group used a Balance® coated open circuit, full systemic heparinisation (activated clotting time > 480 seconds) and conventional cardiotomy suction. This perfusion strategy was evaluated by the chest drain volume after 24 hours, perioperative haemoglobin and platelet loss accompanied by global coagulation assessments. Results: Patients in the study group demonstrated significantly better outcomes signified by lower blood loss 554 ± 224 versus 1,100 ± 989 mL (p < 0.001), reduced packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin −28 ± 15 versus −40 ± 14 g/L (p = 0.004) and platelet loss −35 ± 36 versus −82 ± 67 × 109/L (p = 0.001). Indices of rotational thromboelastometry indicated shorter clotting times within the internal and external pathways. Adenosine diphosphate activated platelet function was within normal range based on Multiplate® aggregometry, while ROTEM® platelet analyses indicated inhibited function both preoperatively and post-bypass. Platelet inhibition by aspirin was verified throughout the perioperative period. Platelet function showed no intergroup differences. Conclusion: A stringent perfusion strategy reduced blood loss and transfusions in dual antiplatelet therapy patients requiring urgent surgery.

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“…The initial results were encouraging[25]. However, postoperative hemorrhage was frequently present, since the direct use of diluted blood serum led to an intense activation of the coagulation cascade and impaired hemostasis[26].…”

Section: Ibsa Devicesmentioning

confidence: 99%

“…Since blood recovered by IBSA does not contain coagulation factors, TEM should be used to assess the efficiency of blood coagulation and the need for hemostasis management[12]. In addition to reducing platelet dysfunction, the processing of blood collected intraoperatively with IBSA reduces the systemic inflammatory response and balances the pro and anti-inflammatory cytokines present in the blood to be reinfused, as compared with direct reinfusion of blood[26]. Two devices are most commonly used for IBSA in surgery, Cell Saver™ and HemoSep™.…”

Section: Ibsa Devicesmentioning

confidence: 99%

Intraoperative cell salvage with autologous transfusion in liver transplantation

Pinto

Chedid

Sekine

et al. 2019

WJGS

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Liver transplant (LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others. Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion. Intraoperative reinfusion of autologous blood is possible through previous self-donation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion (IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.

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Cell saver processing mitigates the negative effects of wound blood on platelet function

Abstract: The results suggest that cell saver processing before retransfusion mitigates the negative effects of wound blood on platelet function despite that cell saver processing reduces platelet count.

Cited by 9 publications

References 20 publications

Diminuição Do Uso De Bolsas De Sangue Em Cirurgias Cardiovasculares Pelo Uso Da Recuperação Intraoperatória De Células

Diminuição Do Uso De Bolsas De Sangue Em Cirurgias Cardiovasculares Pelo Uso Da Recuperação Intraoperatória De Células

Cardiopulmonary bypass and dual antiplatelet therapy: a strategy to minimise transfusions and blood loss

Intraoperative cell salvage with autologous transfusion in liver transplantation

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