Intraoperative blood salvage
Intraoperative blood salvage | |
---|---|
ICD-9 | 99.00 |
MeSH | D057725 |
Intraoperative blood salvage (IOS), also known as cell salvage, is a specific type of autologous blood transfusion. Specifically IOS is a medical procedure involving recovering blood lost during surgery and re-infusing it into the patient. It is a major form of autotransfusion.
It has been used for many years and gained greater attention over time as risks associated with allogenic (separate-donor)
Background
Providing safe blood for transfusion remains a challenge despite advances in preventing transmission of
Much more common risks of allogeneic transfusion include
Other risks such as classic or variant Creutzfeldt–Jakob disease (vCJD), an invariably fatal disease, remain worrisome as there are currently no approved tests for which to screen blood donors for this disease. Blood centers worldwide have instituted criteria to reject donors who may have been exposed to classic CJD and vCJD. Screening for transmissible diseases and deferral policies for classic CJD and vCJD designed to improve safety have unfortunately contributed to shrinking the donor pool. Blood shortages exist in the United States and worldwide. In many industrialized countries 5% or less of the eligible population are blood donors.[citation needed]
As a result, some in the global medical community have moved from allogeneic blood (blood collected from another person) towards
Bloodless options
Ways to avoid the adverse events associated with
- Minimally invasivesurgical techniques
- stem cellsin the bone marrow to produce red blood cells)
- Blood salvage procedures
- Blood substitutes such as blood volume expanders and oxygen carriers (the latter as yet unlicensed in North America)
Blood salvage procedures
Cell processing
Regardless of manufacturer, there are many types of cell processors. Cell processors are red cell washing devices that collect anticoagulated shed or recovered blood, wash and separate the
Direct transfusion
Direct transfusion is a blood salvaging method associated with
Acute normovolemic hemodilution (ANH) is a form of autologous transfusion where whole blood is collected from a patient at the start of surgery into a standard blood collection bag with anticoagulant with the simultaneous replacement of intracellular volume using acellular fluids (such as normal saline). The patient's own blood is re-infused at the end of the surgical case (presumably when any bleeding has stopped).[2]
Ultrafiltration
Hemofiltration or ultrafiltration devices constitute the third major type of blood salvage in operating rooms. In general, ultrafiltration devices filter the patient's anticoagulated whole blood. The filter process removes unwanted excess non-cellular plasma water, low molecular weight solutes, platelet inhibitors and some particulate matter through hemoconcentration, including activated cytokines, anaphylatoxins, and other waste substances making concentrated whole blood available for reinfusion. Hemofilter devices return the patient's whole blood with all the blood elements and fractions including platelets, clotting factors, and plasma proteins with a substantial Hb level. Presently, the only whole blood ultrafiltration device in clinical use is the Hemobag.[3][4] These devices do not totally remove potentially harmful contaminants that can be washed away by most RBC-savers. However, the contaminants that are potentially reduced by using RBC-savers, as shown by data from in vitro laboratory tests, are transient and reversible in vivo with hemostatic profiles returning to baselines within hours. The key is that coagulation and homeostasis are immediately improved with the return of concentrated autologous whole blood.
Over the years numerous studies have been done to compare these methods of blood salvage in terms of safety, patient outcomes, and cost effectiveness, often with equivocal or contradictory results.[5][6][7][8][9]
See also
References
- ISBN 978-0-9558648-9-6.
- ISBN 978-1-56395-840-3.
- ^ Hemobag
- ^ "Noblood - Intraoperative blood salvage". Archived from the original on 2017-11-21. Retrieved 2014-08-23.[full citation needed]
- PMID 2025077.
- PMID 8215672.
- S2CID 44692769.
- PMID 15196326.
- PMID 17672193.
Further reading
- Beckmann SR, Carlile D, Bissinger RC, Burrell M, Winkler T, Shely WW (June 2007). "Improved coagulation and blood conservation in the golden hours after cardiopulmonary bypass". The Journal of Extra-corporeal Technology. 39 (2): 103–8. PMID 17672193.
- Beckmann S, Lynn P, Miller S, Harris R, DiMarco RF, Ross JE (May 2013). "Evaluation of coagulation factors and platelet function from an off-line modified ultrafiltration technique for post-cardiopulmonary bypass circuit blood recovery". Perfusion. 28 (3): 214–22. S2CID 29188839.
- Colli A, Balduzzi S, Ruyra X (2012). "The Hemobag: the modern ultrafiltration system for patients undergoing cardiopulmonary by pass". Journal of Cardiothoracic Surgery. 7: 55. PMID 22697396.
- Delaney E, Rosinski D, Ellis H, Samolyk KA, Riley JB (June 2010). "An in-vitro comparison between Hemobag and non-Hemobag ultrafiltration methods of salvaging circuit blood following cardiopulmonary bypass". The Journal of Extra-corporeal Technology. 42 (2): 128–33. PMID 20648897.
- Harm SK, Waters JH, Lynn P, et al. (March 2012). "Changes in mechanical fragility and free hemoglobin levels after processing salvaged cardiopulmonary bypass circuit blood with a modified ultrafiltration device". The Journal of Extra-corporeal Technology. 44 (1): 21–5. PMID 22730860.
- McNair E, McKay W, Qureshi AM, et al. (December 2013). "Outcomes and biochemical parameters following cardiac surgery: effects of transfusion of residual blood using centrifugation and multiple-pass hemoconcentration". Journal of Cardiothoracic and Vascular Anesthesia. 27 (6): 1174–80. PMID 23988781.
- Moskowitz DM, Klein JJ, Shander A, et al. (September 2006). "Use of the Hemobag for modified ultrafiltration in a Jehovah's Witness patient undergoing cardiac surgery". The Journal of Extra-corporeal Technology. 38 (3): 265–70. PMID 17089515.
- Samolyk KA, Beckmann SR, Bissinger RC (October 2005). "A new practical technique to reduce allogeneic blood exposure and hospital costs while preserving clotting factors after cardiopulmonary bypass: the Hemobag". Perfusion. 20 (6): 343–9. S2CID 1791152.
External links
- UK: Serious Hazards of Transfusion Reports Archived 2006-05-07 at the Wayback Machine (PDF)