Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding

Helm, Robert E.; Klemperer, John D.; Rosengart, Todd K.; Gold, Jeffrey P.; Peterson, Powers; DeBois, William; Altorki, Nasser K.; Lang, Samuel J.; Thomas, Stephen J.; Isom, O. Wayne; Krieger, Karl H.

doi:10.1016/0003-4975(96)00755-2

Cited by 70 publications

(31 citation statements)

References 17 publications

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“…In the present series of patients this advantage was observed during CPB, and IT was not the case considering the intra-operative as a whole, and in the early postoperative period. Patients undergoing cardiac operations who will require transfusions can be predicted before the operation by a number of variables, including red blood cell mass [11]. This is consistent with the assumption that patients with a low red cell mass are more likely to have low hematocrit values and therefore require transfusions after CPB as a result of the proportionately greater hemodilution caused by CPB in these patients.…”

Section: Discussionsupporting

confidence: 58%

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

Reges¹,

Vicente²,

Rodrigues³

et al. 2011

Rev Bras Cir Cardiovasc

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Introduction: Retrograde autologous priming (RAP) is a cardiopulmonary bypass (CPB) method, at low cost. Previous studies have shown that this method reduces hemodilution and blood transfusions needs through increased intraoperative hematocrit.Objective: To evaluate RAP method, in relation to standard CPB (crystalloid priming), in adult patients.Methods: Sixty-two patients were randomly allocated to two groups: 1) Group RAP (n = 27) of patients operated using the RAP and; 2) Control group of patients operated using CPB standard crystalloid method (n = 35). The RAP was performed by draining crystalloid prime from the arterial and venous lines, before CPB, into a collect recycling bag. The main parameters analyzed were: 1) CPB hemodynamic data; 2) Hematocrit and hemoglobin values; 3) The need for blood transfusions.Results: It was observed statistically significant fewer transfusions during surgery and reduced CPB hemodilution using RAP. The CPB hemodynamic values were similar, observing a tendency to use lower CPB flows in the RAP group patients.Conclusion: This investigation was designed to be a small-scale pilot study to evaluate the effects of RAP, which were demonstrated concerning the CPB hemodilution and blood transfusions.

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Section: Discussionsupporting

confidence: 58%

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

Reges¹,

Vicente²,

Rodrigues³

et al. 2011

Rev Bras Cir Cardiovasc

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“…Several possible methods of reducing blood loss and the need for ABT associated with spinal fusion surgery currently exist. These include use of autologous pre-donation of blood [7,11,16,26, 31, 32, 40], blood dilution techniques [4,10,14,15,19,22], erythropoietin [24], use of antifibrinolytics [1,8,9,20,24,27, 30, 34, 35, 41], and use of cell salvage [6, 33]. Prior research on techniques used to reduce the need for ABT has previously been conducted in single-site hospitals or in a small number of patients enrolled in a clinical trial, which does not accurately provide a clear picture of the utilization and cost burden associated with it.…”

Section: Introductionmentioning

confidence: 99%

Cost and utilization of blood transfusion associated with spinal surgeries in the United States

et al. 2006

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IntroductionIn general surgery and in spinal surgery, allogeneic blood transfusions (ABT) have been related to increased post-operative complications [12,13, 37, 39]. As such, reduction in ABT is a high priority in spinal surgery. Recently, techniques to reduce the need for ABT during spinal surgery have surfaced in the orthopedic surgery literature.Understanding the risk factors and costs associated with ABT can help with the discovery of new costeffective methods to reduce its burden. Several possible methods of reducing blood loss and the need for ABT associated with spinal fusion surgery currently exist. These include use of autologous pre-donation of blood [7,11,16,26, 31, 32, 40], blood dilution techniques [4,10,14,15,19,22], erythropoietin [24], use of antifibrinolytics [1,8,9,20,24,27, 30, 34, 35, 41], and use of cell salvage [6, 33]. Prior research on techniques used to reduce the need for ABT has previously been conducted in single-site hospitals or in a small number of patients enrolled in a clinical trial, which does not accurately provide a clear picture of the utilization and cost burden associated with it. The literature has not been able to provide an illustration of the current state of the use and cost of ABT in the US population.

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“…2000 mL of whole blood was removed based on a previously derived formula using the patient's initial hematocrit, the target hematocrit prior to bypass, the CPB pump's prime volume, and the patients estimated blood volume to reach a target hematocrit on bypass of 18%. 1 Euvolemia was maintained using a combination of 2 L of Hextend® (Abbott Laboratories, North Chicago, IL, USA) and 1.3 L of Plasma-Lyte® (Baxter Healthcare Corporation, Deerfield, IL, USA). The patient's mean arterial blood pressure was maintained within 20% to 30% of baseline values.…”

Section: éLéments Cliniques : Un Homme De 47 Ans Témoin De Jéhovah mentioning

confidence: 99%

Multidisciplinary management of a Jehovah’s Witness patient for the removal of a renal cell carcinoma extending into the right atrium

Moskowitz

Perelman

Cousineau

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To highlight the management of a Jehovah's witness surgical patient presenting for cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest. C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 47-yr-old male, Jehovah's Witness, with renal cell carcinoma was admitted for left radical nephrectomy and excision of tumour thrombus extending into the junction of the inferior vena cava (IVC) and right atrium (RA). The preoperative goals were to maximize red blood cell mass, delineate the extent of tumour extension and develop a surgical plan incorporating blood conservation strategies to minimize blood loss. A midline abdominal incision was made to optimize removal of the non-caval portion of the tumour from the intra-abdominal region. CPB and deep hypothermic circulatory arrest were instituted to aid in removing the tumour from the IVC and RA. Intraoperative blood conservation strategies included the use of acute normovolemic hemodilution, antifibrinolytics, cell salvage, point-of-care monitoring of heparin and protamine blood concentrations, leukocyte-depleting filter, and meticulous surgical techniques. The patient was successfully weaned from CPB and was transported to the cardiothoracic intensive care unit without complication. The patient was discharged home one week after the operation with a hemoglobin of 10.2 g·dL -1 and a hematocrit of 31.2%.

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Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding

Cited by 70 publications

References 17 publications

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

Perfusato autólogo retrógrado no circuito de circulação extracorpórea em pacientes adultos

Cost and utilization of blood transfusion associated with spinal surgeries in the United States

Multidisciplinary management of a Jehovah’s Witness patient for the removal of a renal cell carcinoma extending into the right atrium

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