Transfusion of post-operative shed blood: laboratory characteristics and clinical utility

Abstract

IntroductionIt is well known that the defence mechanisms provided by the immune system can be altered by traumatic injury, surgery and transfusions, and there is a growing interest for acquiring greater knowledge on the causes and mechanisms involved in the immunodepression induced by the anaesthetic-surgical procedure, since this increases the susceptibility to post-operative infection and tumour relapse after potentially curative surgery [15, 19,62]. This interest further increases when it is seen that, in spite of current surgical techniques, of advances in anaesthetics and in the huge variety of anti-microbial agents, general and local infection continues to be one of the main causes of morbidity-mortality associated with traumatic injuries and surgery, increasing its incidence in those patients who have received allogeneic blood transfusions (ABT) [29,61].Abstract Increased awareness of the potential hazards of allogenic blood transfusion, such as incompatibility reactions, metabolic and immunologic disorders, or transmission of viral diseases, has led to an emphasis on allogeneic blood alternatives. For orthopaedic surgery, several autologous transfusion modalities have emerged as alternatives to allogeneic blood transfusion, avoiding its immunomodulatory effects. Among them, transfusion or return of post-operative salvaged shed blood has become popular in major orthopaedic procedures. However, although the effectiveness of this blood-saving method is well documented, several authors have questioned its safety and recommended the use of washed blood. Therefore, this review analyses the haematologic characteristics of unwashed filtered shed blood, including metabolic status and survival of red blood cells, the components of the haemostatic system, the content of fat particles, bacterial and tumour cells and the possibility of their removal, the content of inflammatory mediators, and the effects on the patient's immune system. From data reviewed in this paper, it can be concluded that post-operative salvage of blood seems to be an excellent source of functional and viable red cells without many of the transfusion-related risks and with some immuno-stimulatory effects. In addition, from our experience, postoperative re-infusion of unwashed shed blood after major spine procedures has proved to reduce post-operative homologous transfusion requirements and to complement preoperative autologous blood donation, without any clinically relevant complication.

Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation

“…[1][2][3][4][7][8][9][10][11][12][13][14][15] To date there has been no direct comparison between post-and intraoperative blood salvage. In 1995 Huo et al showed intraoperative blood salvage to be more efficient in reducing blood loss in total hip replacements than ABT drains.…”

“…[1][2][3]8 Both intraoperative blood salvage and postoperative retransfusion drains have been shown to be effective in reducing blood loss in total hip arthroplasties. [1][2][3][4][7][8][9][10][11][12][13][14] Intraoperative cell salvage involves collection of blood lost during surgery using a suction device. The blood is centrifuged and washed so that only concentrated red cells are collected and returned to the patient.…”

Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial

“…In addition, the retrospective study design [11], the comparison of a prospective study group with a retrospective control group [22], or the missing randomization procedure in a prospective published trial [7], all postulating a lower ABT rate for the reinfusion group, are critical limitations and therefore not directly comparable to our prospective, randomized study. Some previous studies that have noted only a small or no benefit in reducing the need for postoperative ABT evaluated a retransfusion device for USB [17,18,23,30]. Even when trials reported a lower ABT rate for the autologous retransfusion group, they either found no difference in administered ABT units per patient [7,20,34] or the ABT number per patient transfused was not analyzed [11,22,34] (Table 3).…”

“…In general, retransfusion devices can be divided in two major groups: systems for unwashed shed blood (USB) and systems for washed shed blood (WSB) [21,23]. Owing to the higher related risk of a transfusion reaction to USB (compared with WSB), some authors [12,35,39,40] advise washing the shed blood before retransfusion.…”

The merits of cell salvage in arthroplasty surgery: an overview

“…4,9 Salvaged, unwashed blood has been shown to be substandard, as it is diluted and may contain a high concentration of hemolyzed red blood cells, cytokines and clotting factors. 10 Further risks with the reinfusion of hemolyzed blood include renal failure; disseminated intravascular coagulation (DIC) due to activated clotting or fibrinolytic factors; and risk of fat embolism due to debris, such as fat particles. [10][11][12] Contemporary cell salvage allows for effective reduction of contaminants by cell separation and washing, resulting in an autologous red blood cell concentrate of normal function and viability.…”