Safety and therapeutic effectiveness of reinfused shed blood after open heart surgery

Axford, Trevor C.; Dearani, Joseph A.; Ragno, Gina; Macgregor, H.; Patel, Maitri; Valeri, C. R.; Khuri, S. F.

doi:10.1016/0003-4975(94)90554-1

Cited by 43 publications

(39 citation statements)

References 28 publications

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“…Moreover, as in other studies in knee, hip or spine surgery [2,3,5,6,11,13,14,15,30,32] and cardiac surgery [1,7,28], postoperative reinfusion of unwashed filtered shed blood after major spine procedures has proved to reduce homologous transfusion requirements, with only minor complications. A prospective study, using the Constavac CBC II plus short-time preoperative autologous blood predeposit, is currently in progress to evaluate the impact of this strategy, not only on the prevalence of homologous blood transfusion but also on the haemostatic and immunological status of the patients.…”

Section: Discussionmentioning

confidence: 67%

Postoperative blood salvage and reinfusion in spinal surgery: blood quality, effectiveness and impact on patient blood parameters

Sebastian¹,

Romero²,

Olalla³

et al. 2000

European Spine Journal

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IntroductionThe development of complex surgical procedures for the treatment of orthopaedic diseases and the increasing number of traffic accidents have raised the demand for allogenic blood to a level that often exceeds supply. In addition, the increased awareness of the potential hazards of allogenic blood transfusion, such as incompatibility reactions, metabolic and immunological disorders or transmission of viral diseases, has led to an emphasis on blood saving techniques [10,18,25].Abstract Although reinfusion of salvaged shed blood has become popular in major orthopaedic procedures, this blood saving technique is still controversial. In an effort to assess the functional and metabolic status of shed blood erythrocytes and the impact of postoperative shed blood reinfusion on allogenic blood requirements and patient's blood parameters, analyses of perioperative blood samples were performed in 28 consecutive orthopaedic patients undergoing spinal fusion, in which postoperative shed blood was collected and reinfused with the ConstaVac CBC II device. In comparison with a previous series of 31 patients, this procedure reduced allogenic blood requirements by almost 30% (P < 0.05), without any increase in postoperative complications. Postoperative shed blood presented lower haematological values and higher plasma-free haemoglobin (PFHB) levels than preoperative blood, without any disturbance in morphology, median corpuscular fragility (MCF) or erythrocyte adenosine triphosphate (ATP) and diphosphoglycerate (DPG) content. Serum concentrations of enzymes -glutamate-oxalacetate aminotransferase (GOT), glutamate-piruvate aminotransferase (GPT), creatine kinase (CK), lactate dehydrogenase (LDH) -and inflammatory cytokines (IL-1β, IL-6) were elevated in shed blood. After reinfusion, there was no alteration in coagulation parameters or cytokine levels. Serum levels of some enzymes increased at the end of surgery and remained elevated at postoperative day 2 (CK) or 7 (GOT, LDH), with a higher increase if postoperative autotransfusion was used as a blood saving method. Therefore, caution should be taken when these serum enzyme levels are used for diagnosis. In conclusion, salvaged shed blood in orthopaedic procedures of the spine seems to be an excellent source of red cells which are not significantly damaged, keeping a normal functional and metabolic status, and reduces allogenic blood requirements without significant side effects.

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Section: Discussionmentioning

confidence: 67%

Postoperative blood salvage and reinfusion in spinal surgery: blood quality, effectiveness and impact on patient blood parameters

Sebastian¹,

Romero²,

Olalla³

et al. 2000

European Spine Journal

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“…Baboons were used in this study because previous studies have documented the similarities between baboon and human platelets and clotting proteins 34,35 . This study was performed in the baboon to simulate the transfusion of a volume of shed nonwashed human blood obtained from mediastinal blood following cardiopulmonary bypass surgery 24 . A previous study from our laboratory has documented that heparin produced a platelet dysfunction and fibrinolysis in patients before cardiopulmonary bypass surgery 25 .…”

Section: Discussionmentioning

confidence: 99%

“…The prophylactic treatment of patients subjected to cardiopulmonary bypass surgery with the antifibrinolytic agent epsilon aminocaproic acid has been shown to reduce bleeding in these patients 36 . A study from our laboratory has reported the safety and therapeutic effectiveness of the reinfused nonwashed mediastinal shed blood after open‐heart surgery 24 . In that clinical study, a mean volume of 710 mL + 90 mL of nonwashed shed mediastinal blood with a mean hematocrit of 20 V% was infused.…”

Section: Discussionmentioning

confidence: 99%

“…Fibrinolytic agents such as tissue plasminogen activator (tPA), streptokinase, and urokinase used to treat patients with thrombotic events may produce fibrinogen degradation products (FDP) and D‐dimer that could alter the function of the platelets and clotting proteins and produce a bleeding diathesis 16‐21 . It has been reported that nonwashed shed blood obtained postoperatively from patients subjected to orthopedic procedures and cardiopulmonary bypass surgery did not produce a hemostatic defect when reinfused in a volume equivalent to 15% of the patient's blood volume 22‐24 …”

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Hemostatic Defect in Baboons Autotransfused Treated Plasma to Simulate Shed Blood

et al. 2006

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“…Axford 14 et al showed that SMB undergoes extensive coagulation and clot lysis within the mediastinium and pleural spaces before collection.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three methods of blood conservation in expected bleeders in OPCAB (off pump coronary artery bypass surgery)

Mandke

Gajendragadkar

Hegde

et al. 2002

Indian J Thorac Cardiovasc Surg

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Background. Blood conservation has remained a challenge in the field of cardiac surgery, especially since the advent of OPCAB. This has led us to conduct this study to compare the efficacy of desmopressin, aprotinin bolus doses and aprotinin continuous infusion in controlling the periorative bleeding.Methods. 80 consecutive patients receiving antiplatelets drugs undergoing OPCAB were subjected to one of the three groups. Group A (n=20) received desmopressin 0.2mg/kg over 20 min after induction of anaesthesia. Group B (n=20) received aprotinin 15000 units/kg over 20 min after induction and with protamine. Group C (n=20) received aprotinin 8000 units/Kg over 20 min at induction, repeated with protamine and infusion of aprotinin 4000 units/kg/hr intraoperative & 2000 units/Kg/hr postoperative over 5 hours. Group D (n=20) served as control. Shed mediastinal blood (SMB) was reinfused intraoperatively and postoperatively. Postoperative drainage for first 12 hours was noted. Routing coagulation tests, activated clotting time (ACT) and Thromboelastography (TEG) were used for monitoring coagulation and as guide for blood product transfusion.Results. Postoperative drainage was minimum (198.52±101.35) P=0.0836 and postoperative autotransfusion was significantly low (p=0.0096) in group C. There was no significant difference (P>0.05) between groups in total auto transfusion, rise in serum creatinine and coagulation profile. Surgical field was highly satisfactory in continuous aprotinin group. ANOVA and chi square test were used for statistical significance.Conclusion. Combination of peri-operative autotransfusion and pharmacological methods practically eliminates the need of homologous blood transfusion. Continuous infusion of aprotinin is better than other methods studied. (Ind J Thorac Cardiovasc Surg, 2002; 18: 110-114)

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Safety and therapeutic effectiveness of reinfused shed blood after open heart surgery

Cited by 43 publications

References 28 publications

Postoperative blood salvage and reinfusion in spinal surgery: blood quality, effectiveness and impact on patient blood parameters

Postoperative blood salvage and reinfusion in spinal surgery: blood quality, effectiveness and impact on patient blood parameters

Hemostatic Defect in Baboons Autotransfused Treated Plasma to Simulate Shed Blood

Comparison of three methods of blood conservation in expected bleeders in OPCAB (off pump coronary artery bypass surgery)

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