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Encyclopedia > Intraoperative blood salvage
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Intraoperative autologous blood salvaging has been used for many years. Because of ongoing safety concerns with the blood supply, a priority remains avoiding transfusion-related adverse events, especially in cardiothoracic and vascular surgery in which blood usage has traditionally been high. Several medical devices have been developed to assist in salvaging the patient's own blood in the perioperative setting. In biology, autologous refers to cells, tissues or even proteins that are reimplanted in the same individual as they come from. ... Blood transfusion is the taking of blood or blood-based products from one individual and inserting them into the circulatory system of another. ... A typical modern surgical operation For other uses, see Surgery (disambiguation). ... It has been suggested that this article or section be merged with Medical equipment. ...

Contents


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. Originally known as serum hepatitis, hepatitis B has only been recognized as such since World War II, and has caused current epidemics in parts of Asia and Africa. ... Hepatitis C is a blood-borne viral disease which can cause liver inflamation, fibrosis, cirrhosis and liver cancer. ... HIV (Human Immunodeficiency Virus) is a retrovirus that infects cells of the human immune system. ... West Nile virus is a virus of the family Flaviviridae, found in both tropical and temperate regions. ... Subgroups Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular: bacterium) are a major group of living organisms. ... Infected (Radio Show) is also the name of an internet radio podcast hosted by Martin Sargent. ... A patient is the name given to any person who is ill or injured and is being treated by, or in need of treatment by, a physician or other medical professional. ...


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 (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. Dyspnea (Latin dyspnoea, Greek dyspnoia from dyspnoos - short of breath) or shortness of breath (SOB) is perceived difficulty breathing or pain on breathing. ... See Fever for the Kylie Minogue album; Fever is also a song by Otis Blackwell. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ...


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. Creutzfeldt-Jakob Disease (CJD) is a very rare and incurable brain disease that is ultimately fatal. ...


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 when the blood is kept in a continuous circuit and connected at all times. Blood donation is a process by which a blood donor voluntarily has blood drawn for storage in a blood bank for subsequent use in a blood transfusion. ...


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: The last twenty years have witnessed a surge of interest in bloodless surgery, for a variety of reasons. ...

  • 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. A minimally invasive medical procedure is defined as one that is carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest damage possible to these structures. ... Erythropoietin Erythropoietin (or EPO) is a glycoprotein hormone that is a growth factor for erythrocyte (red blood cell) precursors in the bone marrow. ... Mouse embryonic stem cells. ... Blood substitutes are used to fill fluid volume and/or carry oxygen and other gases in the cardiovascular system. ...


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:

  1. Cell processors and salvage devices that wash and save red blood cells, i.e., "cell washers" or RBC-savers
  2. Direct transfusion
  3. 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. Human red blood cells Red blood cells are the most common type of blood cell and are the vertebrate bodys principal means of delivering oxygen to body tissues via the blood. ... Cytokines are small protein molecules that regulate communication among immune system cells and between immune cells and those of other tissue types. ... Anaphylatoxin, or anaphylotoxin, is a fragment (C3a, C4a or C5a) of the complement system that triggers degranulation of (release of substances from) mast cells or basophils, which is an important part of the immune system in all kinds of inflammation and especially as part of defense against parasites. ... A 250 ml bag of newly collected platelets. ... Coagulation is the thickening or congealing of any liquid into solid clots. ... Homeostasis is the property of an open system, especially living organisms, to regulate its internal environment to maintain a stable, constant condition, by means of multiple dynamic equilibrium adjustments, controlled by interrelated regulation mechanisms. ...


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. A coronary artery bypass graft (CABG) or heart bypass is a surgical procedure performed in patients with coronary artery disease (see atherosclerosis) for the relief of angina and possible improved heart muscle function. ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... A diuretic is any drug that elevates the rate of bodily urine excretion (diuresis). ...


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 plasma water, low molecular weight solutes 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. Wiktionary has a definition of: In vitro In vitro (Latin: within glass) means within a test tube, or, more generally, outside a living organism or cell. ... In vivo (Latin for (with)in the living). ...


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 (References 1-4).


References

  1. Boldt J, Zickmann B, Fedderson B, Herold C, Dapper F, Hempelmann G. Six different hemofiltration devices for blood conservation in cardiac surgery. Ann Thorac Surg 1991 May;51(5):747-53.
  2. Sutton RG, Kratz JM, Spinale FG, Crawford FA Jr. Comparison of three blood-processing techniques during and after cardiopulmonary bypass. Ann Thorac Surg 1993 Oct;56(4):938-43.
  3. Eichert I, Isgro F, Kiessling AH, Saggau W. Cell saver, ultrafiltration and direct transfusion: comparative study of three blood processing techniques.Thorac Cardiovasc Surg 2001 Jun;49(3):149-52.
  4. Freischlag JA. Intraoperative blood salvage in vascular surgery - worth the effort? Crit Care 2004;8 Suppl 2:S53-6.

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

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