Experimental Study on Intraoperative Autotransfusion During Urological Operation

Abstract

The value of autotransfusion is widely recognized in the surgical community and may be of increasing importance in prevention of acquired immunodeficiency syndrome and hepatitis. The concern of possible contamination of the blood with urine, bacteria in urine or viable tumor cells has limited the wide use of intraoperative autotransfusion (IAT) in urological operation. There have been no experimental reports about protection of the blood from such contamination. To investigate separation of the blood from a contaminated mixture by using an autotransfusion machine, Haemonetic Cell Saver, a study composed of three experiments was performed. First, 200 ml of blood was mixed 200 ml of urine, and thereafter, the mixture was processed by the machine and the concentration erythrocytes were collected in a bag. Biochemical analysis of the collected erythrocyte solution (CES) was performed. Second, 200 ml of blood was mixed with 200 ml of urine that was adjusted to contain each 10(7)/ml of four bacterial strains. The bacteriological study of the CES was performed. Third, 200 ml of blood was mixed with 200 ml of urine that was adjusted to contain 10(7) cancer cells. Two cell lines, KK47 originated from human bladder cancer and ACHN originated from human renal cell carcinoma was used. The cytological study of the CES was performed. The results of these experiments were: Urine constituents were completely removed from the mixture. However, all strains of bacteria could not be separated, although the number of bacteria decreased. Cancer cells were found in the CES. In conclusion IAT should be done at urological operation in selected patients that have sterile urine and do not have tumor cells in the operation field.

Analysis of peripheral blood for prostate cells after autologous transfusion given during radical prostatectomy

“…The use of IAT during RP has remained controversial because of conflicting evidence on the risk of haematogenous tumour dissemination. Several in vitro studies suggested that tumour cells are not cleared during Cell Saver blood processing [6,10,11], but retrospective studies showed no greater risk of prostate cancer recurrence when IAT was used [2,3]. Other specialities have also reported no greater rate of tumour recurrence or metastasis when IAT is used during oncological surgery [12–14].…”

Washing and filtering of cell‐salvaged blood – does it make autotransfusion safer?

“…Washing has been shown to eliminate or significantly reduce chemical and physical contaminants. In terms of bodily fluids, one study shows complete removal of urine from a 50% blood : urine mix by washing 73 . Even so, there have not been any reports of adverse clinical events due to transfusion of unwashed salvaged blood that has become admixed with urine 43 .…”

“…The concern is inducing metastatic spread of the cancer that is being operated on. It has been shown that salvaged blood from cancer surgery does contain tumor cells, and that washing alone is not enough to remove them 73,84,85 . To reduce the number of potentially malignant cells, leukocyte depletion filters have been advocated and have been shown to reduce the number of tumor cells 85–87 .…”

Infected and malignant fields are an absolute contraindication to intraoperative cell salvage: fact or fiction?

“…Park et al . (1991 , 1997) investigated the efficacy of the ICS washing step for removing bacteria and urine from salvaged blood.…”

“…(1991 , 1997) investigated the efficacy of the ICS washing step for removing bacteria and urine from salvaged blood. In the first series of three experiments ( Park et al ., 1991 ), 200 mL of blood was mixed with 200 mL of urine and then processed on a Haemonetics Cell Saver, and the cell concentrate (CC) was biochemically analysed. Next 200 mL of blood was mixed with 200 mL of urine, which had been contaminated with 10 7 organisms mL −1 of each of four bacterial strains and the resulting CC was cultured.…”