Current Status of the Use of Salvaged Blood in Metastatic Spine Tumour Surgery

Kumar, Naresh; Ravikumar, Nivetha; Tan, Joel Yong Hao; Akbary, Kutbuddin; Patel, Ravish; Kannan, R.

doi:10.14245/ns.1836140.070

Cited by 18 publications

(16 citation statements)

References 89 publications

(119 reference statements)

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“…Special filters for their elimination increase the cost and affect the flow conditions during retransfusion, resulting in the activation of the complement system. In the case of immunosuppressed or cancer patients, leucodepletion of these concentrates could be considered for safety reasons during major orthopedic surgery (18) , (19) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Blood Processed by Cell Saver in Pediatric Scoliosis

García

Rey

Martínez

2020

jmrhs

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Introduction:We study the hematological and microbiological characteristics from the autologous blood processed through the intraoperative cell saver used in our centre (Orthopat®) during the correction of pediatric scoliosis, which is known to be a potentially bleeding surgery. Material and methods: Descriptive analysis of 31 patients undergoing pediatric scoliosis surgery. All of them received blood processed by cell saver intraoperatively. The variables collected were: demographic data, volume of the autogenous red blood cell (RBC) concentrate, blood count, biochemistry, blood culture, preoperative and postoperative blood tests of the patients, incidence of fever during reinfusion of RBC concentrate, postoperative surgical site infections and length of hospital stay. Results: Average volume obtained 288.06ml (sd 154.68). Hematocrit 70.38% (sd 10.03) in accordance with cell-saver commercial data (75%). Of the blood samples obtained, 42.86% had blood cultures that were positive for aerobes and 48.28% for anaerobes. The relation between postoperative infections and contamination of blood concentrates was not statistically significant. When comparing the pre-surgery and post-surgery analytical samples, statistically significant differences (p <0.05) were found in the following: hemoglobin and hematocrit decreased in the postoperative period, while coagulation parameters show a tendency to coagulopathy. Conclusion: Our cell saver obtains RBC concentrates with a percentage of hematocrit in agreement with available information. The reinfusion of them is safe from an infectious and biochemical point of view, but its immunological implications are not clear. This surgery continues to result in a significant loss of blood. Measures taken to avoid allogenic transfusions remain necessary and should be enhanced.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Blood Processed by Cell Saver in Pediatric Scoliosis

García

Rey

Martínez

2020

jmrhs

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“…An extension of this review concluded clinical safety of ICS for this indication, providing evidence for decreased risk for postoperative infections and tumour recurrence, and supported the use of ICS even without LDF in metastatic spinal tumour surgery. This is still controversial for many clinical practitioners [47].…”

Section: Metastatic Spinal Tumour Surgerymentioning

confidence: 99%

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

2022

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Oncological surgery, obstetric haemorrhage and severe trauma are the most challenging conditions for establishing clinical recommendations for the use of cell salvage. When the likelihood of allogeneic transfusion is high, the intraoperative use of this blood-saving technique would be justified, but specific patient selection criteria are needed. The main concerns in the case of oncological surgery are the reinfusion of tumour cells, thereby increasing the risk of metastasis. This threat could be minimized, which may help to rationalize its indication. In severe peripartum haemorrhage, cell salvage has not proven cost-effective, damage control techniques have been developed, and, given the risk of fetomaternal alloimmunization and amniotic fluid embolism, it is increasingly out of use. In trauma, bleeding may originate from multiple sites, coagulopathy may develop, and it should be evaluated whether re-transfusion of autologous blood collected from uncontaminated organ cavities would be feasible. General safety measures include washing recovered blood and its passage through leukocyte depletion filters. To date, no well-defined indications for cell salvage have been established for these pathologies, but with accurate case selection and selective implementation, it could become safe and effective. Randomized clinical trials are urgently needed.

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“…Evaluation tools for this were regression, uni-/multivariate analysis, or sensitivity/specificity. We analyzed accuracy of SINS category divided into two groups (SINS, 0-6 vs. 7-18) or three groups (SINS, 0-6 vs. 7-12 vs. [13][14][15][16][17][18]. We also evaluated accuracy of each component of the SINS (location, pain, bone lesion, radiologic alignment, body collapse, and posterolateral involvement) if data were available.…”

Section: Search Strategy and Study Selection Criteriamentioning

confidence: 99%

“…In the past, external beam radiotherapy had been the cornerstone of treatment for painful spinal metastases [ 35 ]. Since the study of Patchell et al [ 26 ] in 2005, direct surgical decompression and stabilization in patients with metastatic epidural spinal cord compression has been feasible and demonstrated better outcomes [ 14 , 18 , 25 , 38 ]. As surgical outcomes have been enhanced, consultations for surgery have increased to include spinal metastasis [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Is the Spinal Instability Neoplastic Score Accurate and Reliable in Predicting Vertebral Compression Fractures for Spinal Metastasis? A Systematic Review and Qualitative Analysis

Lee

Hong

Lee

et al. 2021

J Korean Neurosurg Soc

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Spinal metastases can present with varying degrees of mechanical instability. The Spinal Instability Neoplastic Score (SINS) was developed as a tool to assess spinal neoplastic-related instability while helping to guide referrals among oncology specialists. Some previous papers suggested that the SINS was accurate and reliable, while others disagreed with this opinion. We performed a systematic review regarding the SINS to evaluate its accuracy and precision in predicting vertebral compression fractures (VCFs). The 21 included studies investigated a total of 2118 patients. Thirteen studies dealt with the accuracy of SINS to predict postradiotherapy VCFs, and eight dealt with the precision. Among 13 studies, 11 agreed that the SINS categories showed statistically significant accuracy in predicting VCF. Among eight studies, body collapse was effective for predicting VCFs in six studies, and alignment and bone lesion in two studies. Location has no statistical significance in predicting VCFs in any of the eight studies. The precision of SINS categories was substantial to excellent in six of eight studies. Among the six components of the SINS, the majority of the included studies reported that location showed near perfect agreement; body collapse, alignment, and posterolateral involvement showed moderate agreement; and bone lesion showed fair agreement. Bone lesion showed significant accuracy in predicting VCFs in half of eight studies, but displayed fair reliability in five of seven studies. Although location was indicated as having near perfect reliability, the component showed no accuracy for predicting VCFs in any of the studies and deleting or modifying the item needs to be considered. The SINS system may be accurate and reliable in predicting the occurrence of postradiotherapy VCFs for spinal metastasis. Some components seem to be substantially weak and need to be revised.

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Current Status of the Use of Salvaged Blood in Metastatic Spine Tumour Surgery

Cited by 18 publications

References 89 publications

Evaluation of Blood Processed by Cell Saver in Pediatric Scoliosis

Evaluation of Blood Processed by Cell Saver in Pediatric Scoliosis

Cell Salvage in Oncological Surgery, Peripartum Haemorrhage and Trauma

Is the Spinal Instability Neoplastic Score Accurate and Reliable in Predicting Vertebral Compression Fractures for Spinal Metastasis? A Systematic Review and Qualitative Analysis

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