Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Cell Saver system is the method of choice for red blood cell salvage from the surgical field; however, cost is a limiting factor. We at our institute have devised a cost-effective version of dialyser-based autotransfusion system. We performed pretransfusion comparison of our autotransfusion system with conventional cell saver system. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A prospective randomized observational study was performed in 104 consecutive patients with coronary artery disease undergoing by off-pump coronary artery bypass grafting. Patients were divided into two groups. In the dialyser group (53 patients), blood from surgical field was salvaged by our dialyser-based system. In the cell saver group (51 patients), blood was salvaged by cell saver. In both groups, 20-mL sample from the salvaged blood was analyzed for hemoglobin, platelets, protein, albumin, free hemoglobin, osmotic fragility, and peripheral blood smear examination. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Total hemoglobin salvaged was comparable in both groups (85% vs 76%). On peripheral smear, red blood cells were swollen, but morphology was preserved. Moreover, normal osmotic fragility suggested absence of any lethal damage to red blood cells in either group. Dialyser-based system was more efficient in salvaging platelets (42.9% vs 6%), proteins (79.2% vs 0%), and albumin (65% vs 0%). Total free hemoglobin was three times more in dialyser group but was well below recommended limits. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Dialyser-based system is economical, is equally efficacious in salvaging red blood cells, is more effective in salvaging platelets and proteins, and does not contain significant amount of free hemoglobin. Therefore, this salvaged blood can be safely transfused. </jats:p></jats:sec>

A physiology‐based trigger score to guide perioperative transfusion of allogeneic red blood cells: A multicentre randomised controlled trial

“…Recovered blood was heparinised at 200 U per 100 ml blood, centrifuged and washed prior to infusion. 10 Transfusion of allogeneic RBCs was always conducted after intraoperative blood salvage transfusion.…”

The effectiveness of cell salvage in extracorporeal circulation surgeries in relation to use of health resources after use: A systematic review and meta-analysis

“…Nevertheless, the results are inconclusive depending on the aspect evaluated, and controversy exists. While several studies suggest that the use of Cell Salvage substantially reduces allogeneic blood transfusions [ [54] , [55] , [56] , [57] , [58] , [59] , [60] ], other authors argue the opposite [ [61] , [62] , [63] ]. In this regard, according to a study by Stoneham et al [ 61 ], patients operated on using Cell Salvage had to be transfused with other allogeneic components within the first 24 h postoperatively.…”

Intraoperative cell salvage with autologous transfusion in liver transplantation

“…Approximately 70% of the blood collected can be reinfused[6]. A crucial step is the clearance of free hemoglobin from the reinfused blood, because this molecule can promote pulmonary, renal, and platelet dysfunction[28]. The red blood cells are then resuspended in saline to a hematocrit of 50%-70%, thus being ready for reinfusion.…”