Intraoperative blood salvage
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Intraoperative blood salvage, also known as autologous blood salvage, is a medical procedure involving recovering blood lost during surgery and re-infusing it into the patient.
It has been used for many years and gained greater attention over time as risks associated with allogenic blood transfusion have seen greater publicity and more fully appreciated. Several medical devices have been developed to assist in salvaging the patient's own blood in the perioperative setting. These are used frequently in cardiothoracic and vascular surgery, in which blood usage has traditionally been high. With a greater effort to avoid adverse events due to transfusion there as also been an emphasis on blood conservation (see bloodless surgery).
Background
Providing safe blood for transfusion remains a challenge despite advances in preventing transmission of hepatitis B, hepatitis C, AIDS/HIV, West Nile virus(WNV), and transfusion-transmitted bacterial infection. Human errors such as misidentifying patients and drawing blood samples from the wrong person present much more of a risk than transmissible diseases.
Additional risks include transfusion-related acute lung injury, a potentially life-threatening condition with symptoms such as dyspnea, fever, and hypotension occurring within hours of transfusion transfusion related acute lung injury (TRALI), and transfusion-associated immunomodulation,which may suppress the [immune response] and cause adverse effects such a small increase in the risk of postoperative infection.
Other risks such as variant Creutzfeldt-Jakob disease (vCJD), an invariably fatal disease, remain worrisome. Blood centers worldwide have instituted criteria to reject donors who may have been exposed to vCJD. Screening for transmissible diseases and deferral policies for vCJD designed to improve safety have 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.
As a result, the global medical community has increasingly moved from allogenic blood (blood collected from another person) towards autologous infusion, in which patients receive their own blood. Another impetus for autologous transfusion is the position of Jehovah's Witnesses on blood transfusion. For religious reasons, Jehovah's Witnesses will not accept any allogeneic transfusions from a volunteer's blood donation, but may accept the use of autologous blood salvaged during surgery to restore their blood volume and homeostasis during the course of an operation.
Bloodless options
Ways to avoid the adverse events associated with allogenic transfusion are often grouped under the umbrella term bloodless surgery. There are several so-called bloodless options. These include:
- Minimally invasive surgical techniques
- Erythropoietin (a hormone that stimulates peripheral stem cells in the bone marrow to produce red blood cells)
- Blood substitutes such as blood volume expanders and oxygen carriers (the latter as yet unlicensed in North America)
- Autologous blood donation, including pre-operative donation (suitable only for scheduled surgery in which transfusion is anticipated) and intraoperative autologous donation and blood salvage.
Intraoperative blood salvage has been used for many years, especially in cardiothoracic and vascular surgery, where blood usage has traditionally been high.
Blood salvage procedures
Several processes have been developed to assist in salvaging the patient's own whole blood in the perioperative setting. These can be categorized into three general types of salvage procedures:
- Cell processors and salvage devices that wash and save red blood cells, i.e., "cell washers" or RBC-savers
- Direct transfusion
- Ultrafiltration of whole blood
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 red blood cells (RBCs) by centrifugation, and reinfuse the RBCs. RBC washing devices can help remove byproducts in salvaged blood such as activated cytokines, anaphylatoxins, and other waste substances that may have been collected in the reservoir suctioned from the surgical field. However, they also remove viable platelets, clotting factors, and other [plasma proteins] essential to whole blood and homeostasis. The various RBC-savers also yield RBC concentrates with different characteristics and quality.
Direct transfusion is a blood salvaging method associated with cardiopulmonary bypass (CPB) circuits or other extracorporeal circuits (ECC) that are used in surgery such as coronary artery bypass grafts (CABG), valve replacement, or surgical repair of the great vessels. Following bypass surgery the ECC circuit contains a significant volume of diluted whole blood that can be harvested in transfer bags and re-infused into patients. Residual CPB blood is fairly dilute ([Hb] = 6–9 g/dL; 60–90 g/L) compared to normal values (12–18 g/dL; 120–180 g/L) and can also contain potentially harmful contaminants such as activated cytokines, anaphylatoxins, and other waste substances that have been linked to organ edema and organ dysfunction and need a diuretic to reverse.
Hemofiltration or ultrafiltration devices constitute the third major type of blood salvage appearing 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. 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[1][1][1][1].
References
See also
External links
- UK: Serious Hazards of Transfusion Reports (pdf)
- Transfusion-associated adverse events
- Anemia Institute
- Bloodless Medicine
- NATA, the Network for Advancement of Transfusion Alternatives
- NoBlood.Org
- Physicians and Nurses for Blood Conservation
- SABM, the Society for the Advancement of Blood Management
Transfusion medicine | |
|---|---|
| General concepts | Apheresis (Plasmapheresis, Plateletpheresis, Leukapheresis) - Blood transfusion - Coombs test - Cross-matching - Exchange transfusion - International Society of Blood Transfusion - Intraoperative blood salvage - ISBT 128 - Transfusion reactions |
| Human blood group systems - Blood type | ABO - Chido-Rodgers - Colton - Cromer - Diego - Dombrock - Duffy - Gerbich - GIL - Hh - Ii - Indian - JMH - Kell (Xk) - Kidd - Knops - LW - Lewis - Lutheran - MNS - OK - P - Raph - Rh - Scianna - T-Tn - Xg - Yt - Other |
| Blood products | Blood donation - Blood substitutes - Cryoprecipitate - Platelets - Plasma - Red blood cells - Whole blood |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
