Red cell salvage in orthopedic surgery

Abstract

SUMMARY The increasing number of surgical procedures has raised the demand for allogeneic blood to a level that often exceeds supply. Moreover, 10% of all transfusions are given in the orthopedic surgery setting, requiring the avoidance of liberal transfusion criteria to further reduce the risk of infection and other complications. As a result, a series of blood‐conservation measures have been developed. In this article, we review the use of autologous transfusion in orthopedic surgery, with a special focus on perioperative red cell salvage. From data reviewed, it can be concluded that perioperative salvage of blood, either intraoperative cell salvage or postoperative cell salvage, seems to be an excellent source of functional and viable red cells, without many of the transfusion‐related risks and with few side effects. The effectiveness of perioperative cell salvage to reduce exposure to allogeneic blood is greatly enhanced by the implementation of a restrictive transfusion protocol and the association with other blood‐sparing strategies [preoperative autologous blood donation (PABD), erythropoietin, intravenous iron], especially in anemic patients. Moreover, perioperative cell salvage may reduce the number of required PABD units or render PABD unnecessary. Finally, although formal cost‐effectiveness studies on perioperative cell salvage are lacking, based on current allogeneic blood transfusion costs, it is generally accepted that the equivalent of at least one unit of blood needs to be recovered for these techniques to be cost‐effective. Therefore, these procedures should be used on a case‐by‐case basis.

Hemolysis and red blood cell mechanical fragility in shed blood after total knee arthroplasty

“…11 However, we found that the amount of PFHb reinfused with the washed salvaged product was identical to that of the unwashed system. Muñoz and colleagues 12 have previously reported a free Hb washout of 96% with the washed device employed in this study. While this washout percentage is impressive, it does not specify the maximum amount of PFHb that will be returned to the recipient since the residual amount of PFHb depends on the amount of PFHb that is present before washing.…”

Preoperative autologous blood donation in Spain (1994–2004)

“…PABD increased from 15 123 units in 1994 to 24 390 units in 2004, with fluctuations between years (Table 1). The commonest area of application of PABD was orthopaedic surgery procedures where 80% of the collected PABD units were actually transfused [3]. When expressed as percentage of ABD, there was a discrete rise in PABD between 1994 and 1997.…”

International Forum on ‘Perioperative blood salvage’: a Spanish contribution

“…We found that postoperatively collected unwashed filtered shed blood after orthopaedic is safe and effective in reducing allogeneic blood transfusion requirements [2]. We retransfuse drained blood if a minimum of 400 ml are collected within the first six postoperative hours, and up to a maximum of 1000–1200 ml.…”

“…However, the contribution of unwashed filtered shed blood return to allogeneic blood transfusion reduction decreases if a transfusion protocol is adopted. From these data it can be inferred that a transfusion protocol does in itself reduce by 25–30% the relative risk for allogeneic blood transfusion and, therefore, it must be the first strategy to include in a blood saving program [2].…”

“…In contrats, tissue debris and cells in unwashed filtered shed blood are easily detected using a standard blood cytometer, and eliminated by filtration, whereas chemical contaminants (cytokines, heparin, plasma haemoglobin, etc.) are not [2]. However, in our experience, the return of unwashed filtered shed blood after orthopaedic surgery does not modify the postoperative acute phase response [3] or the postoperative cellular immune response [4].…”