Washing and filtering of cell‐salvaged blood – does it make autotransfusion safer?

König, Gerhardt; Waters, Jonathan H.

doi:10.1111/j.1778-428x.2012.01155.x

Cited by 21 publications

(22 citation statements)

References 74 publications

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“…This practice gained popularity in the 1990s in patients undergoing total joint arthroplasty, and is sometimes referred to by the term ‘flip and drip’ since the shed blood was reinfused after filtering, but without washing. There are several limitations with this method . First, the need to anticoagulate the shed blood is controversial.…”

Section: Postoperative Autotransfusionmentioning

confidence: 99%

“…Other concerns with salvaged blood include non‐immune haemolysis from shear forces at the suction tip and mechanical stress induced by the centrifugation and washing . Air embolism has been reported with the older systems when directly attached to the patients IV tubing, and incomplete washing may introduce fat particles or free haemoglobin, and potentially tissue fragments into the circulation .…”

Section: Potential Problems With Salvaged Bloodmentioning

confidence: 99%

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Autologous blood salvage in the era of patient blood management

et al. 2017

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Almost 150 years after the first autologous blood transfusion was reported, intraoperative blood salvage has become an important method of blood conservation. The primary goal of autologous transfusion is to reduce or avoid allogeneic red blood cell transfusion and the associated risks and costs. Autologous salvaged blood does not result in immunological challenge and its consequences, provides a higher quality red blood cell that has not been subjected to the adverse effects of blood storage, and can be more cost-effective than allogeneic blood when used for carefully selected surgical patients. Cardiac, orthopaedic and vascular surgery procedures with large anticipated blood loss can clearly benefit from the use of cell salvage. There are safety concerns in cases with gross bacterial contamination. There are theoretical safety concerns in obstetrical and cancer surgery; however, careful cell washing as well as leucoreduction filters makes for a safer autologous transfusion in these circumstances. Further studies are needed to determine whether oncologic outcomes are impacted by transfusing salvaged blood during cancer surgery. In this new era of patient blood management, where multimodal methods of reducing dependence on allogeneic blood are becoming commonplace, autologous blood salvage remains a valuable tool for perioperative blood conservation. Future studies will be needed to best determine how and when cell salvage should be utilized along with newer blood conservation measures.

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Section: Postoperative Autotransfusionmentioning

confidence: 99%

Section: Potential Problems With Salvaged Bloodmentioning

confidence: 99%

Autologous blood salvage in the era of patient blood management

et al. 2017

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“…Washing is thought to remove these proteins and cell breakdown products. However, there is a paucity of convincing evidence that proves that the differences between washed and unwashed salvaged blood lead to any differences in clinical outcomes 14 . Regardless, in a surgical setting such as TKA where there is already heightened concern for postoperative deep vein thromboses and pulmonary emboli, it is prudent to examine the changes in the patient's coagulation profile caused by routine operative and postoperative interventions to determine if they might predispose the patients to these serious thrombotic complications.…”

Section: Discussionmentioning

confidence: 99%

The effect of salvaged blood on coagulation function as measured by thromboelastography

2012

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BACKGROUND There is concern that salvaged blood has the potential to activate the coagulation system, which might place patients at risk of thrombotic complications. The aim of this study was to determine whether transfusion of salvaged blood after total knee arthroplasty (TKA) would lead to procoagulopathic changes as measured by thromboelastography (TEG), and furthermore if washing would reduce this risk. STUDY DESIGN AND METHODS Twenty two patients undergoing TKA were enrolled. Control samples were venous blood samples taken before surgery. Test samples were created by mixing the control samples with postoperatively salvaged blood, either washed or unwashed. TEG profiles were measured, noting the time to initiate clotting (R), the time of clot formation (K), the angle of clot formation (α-angle), and the maximum strength of clot (MA). RESULTS The changes in the coagulation profile from control samples to test samples were consistent for both the washed and unwashed groups: R time decreased, MA decreased, and K and alpha-angle remained the same. However, the changes were more pronounced in the unwashed group than the washed group, with a 61% decrease in R time as compared with 14%, and a 26% drop in MA as compared with 6%. CONCLUSION The addition of salvaged blood to the patient’s preoperative blood resulted in decreased clot strength as well as decreased time to initial clot formation. This suggests that the reinfusion of postoperatively salvaged washed or unwashed blood after TKA favors a change towards a more hypocoagulable state, and washing appears to reduce this effect.

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“…Еще одной альтернативой аллогенной гемотрансфузии может быть сбор и возврат неотмытой фильтрованной крови из дренажей в первые 6 ч после операции [24]. Реинфузия неотмытых эритроцитов ассоциируется с такими побочными эффектами, как артериальная гипотензия, озноб, фебрильная реакция, повышенная послеоперационная кровоточивость и некардиогенный отек легких [43]. Кроме того, применение данной методики повышает финансовые расходы [44].…”

Section: реинфузия дренажной кровиunclassified

Patient blood management in orthopedic surgery

Borisov¹,

Киров²

2019

Anesteziologiya I Reanimatologiya

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Эндопротезирование улучшает качество жизни пациентов с конечной стадией дегенеративных заболеваний суставов нижних конечностей, и количество таких операций неуклонно растет. Эндопротезирование крупных суставов сопровождается большой кровопотерей, высокой частотой послеоперационной анемии и гемотрансфузий. Анемия и аллогенная гемотрансфузия увеличивают послеоперационную заболеваемость и летальность. Минимизировать потребность в препаратах донорской крови и в то же время предотвратить развитие анемии позволяет менеджмент крови пациента (МКП)-основанный на доказательствах мультидисциплинарный, мультимодальный подход к оптимизации лечения пациентов, потенциально нуждающихся в аллогенной трансфузии. В обзоре приведен анализ результатов исследований по проблеме эффективности компонентов МКП в ортопедии при эндопротезировании крупных суставов. Отмечено, что имеется доказательная база эффективности выявления и лечения предоперационной анемии, периоперационного использования транексамовой кислоты и препаратов железа для внутривенного введения, ограничительного подхода к гемотрансфузии в снижении частоты анемии и аллогенной гемотрансфузии. Эритропоэтин и методы аутогемотрансфузии не подходят для рутинного применения, но могут быть полезны в отдельных случаях. Влияние многих методов на исход требует дальнейшего изучения.

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Washing and filtering of cell‐salvaged blood – does it make autotransfusion safer?

Cited by 21 publications

References 74 publications

Autologous blood salvage in the era of patient blood management

Autologous blood salvage in the era of patient blood management

The effect of salvaged blood on coagulation function as measured by thromboelastography

Patient blood management in orthopedic surgery

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