The collection reservoirs are generally available with filter sizes ranging from 40—120 µ. J Bone Joint Surg Br 1997;79: 630— 2. Blood Salvage Efficiency Mathematical modeling of blood salvage has revealed that small changes in red cell processing efficiency can make large differences in the maximum allowable blood loss that a patient can sustain before allogeneic transfusion therapy. The technique is successful in cases in which no adverse reaction occurs during the blood transfusion process, hemoglobin and hematocrit levels are within the normal range before and after autologous blood donation, before and after transfusion, and before discharge. Over administration of heparin during shed blood salvage is of no consequence in a cell-washing system. For this review, the intraoperative form of blood salvage will be the focus. The impact of blood salvage processing on blood that has been bacterially contaminated was first investigated by Boudreaux, who inoculated expired units of blood with bacteria and found that washing was capable of reducing contamination to 5—23% of the starting contamination.
If sufficient blood is collected and the patient loses sufficient blood to require transfusion, the salvaged blood can be centrifuged and washed in a closed, automated system. So, the importance of administration of tumor cells via blood salvage blood must be questioned. However, due to its limitations, we should gradually develop more reasonable approaches of autotransfusion to adapt the technique for clinical treatment and surgery. Blood Bank North Holland, Amsterdam. Effects on blood cells, plasma chemistry, and whole blood rheology.
Therefore, this technology has a secure and efficient advantage when applied in preoperative autologous transfusions. Blood loss after total knee replacement. In the postoperative setting, where the volume of shed blood is relatively small, the blood is sometimes washed but is generally readministered in an unwashed state. If blood is administered directly from the primary reinfusion bag, the patient is placed at risk of air embolism. It may cause long-term effects on immunization, which would likely lead to micro-thrombosis, blood coagulation and hemolytic reactions. Compared with whole blood collection, patients who underwent apheresis had fewer hospitalization days, faster recovery of postoperative hemoglobin levels, and lower incidence of adverse reactions. Pumping of shed blood is continued until the packed red cells nearly fill the bowl and the advancing erythrocyte column reaches the midpoint of the upper bowl shoulder.
At present, the application of intraoperative or postoperative autotransfusion has been expanded. This article describes the technology, how it works, and how to maximize the utility of the system. To empty the washed blood, the roller pump is reversed, and clean, packed red cells are aspirated from the bowl through the central straw into a primary reinfusion bag. Allogeneic transfusion, or transfusion of blood banked blood has been associated with a litany of complications for the recipient. This Guideline has been updated to reflect the newest developments in patient care during the perioperative period. This technology is widely used for allogeneic blood component collection such as platelets, plasma and erythrocytes.
Theoretical concerns about amniotic fluid embolism have not been borne out in practice, although gross fluid contamination should be aspirated before blood collection and the harvested red cells should be reinfused through a leucodepletion filter. Definite contraindications would include anything that results in red cell lysis. Thus, it has been widely used in clinical treatment and in the surgical field - , achieving remarkable results. It is important to keep in mind that during the course of most operations, a bacteremia is present related to the surgical trauma. However, extensive clinical experience suggests this is not a significant risk although it is recommended to reinfuse the red cells through a leucodepletion filter.
The sustainable blood loss rises to 13,750 ml if 70% red cell recovery is achieved. Platelet cryopreservation technology has continuously gained more attention worldwide. The American Association of Blood Banks guidelines recommend that intraoperative or postoperative autotransfusion should be performed in surgeries where a large amount of bleeding more than 20% total volume is anticipated. These two conditions were not always easy to achieve, especially in the rural setting. Blood conservation methods are not ideal; due to storage of whole blood at 4°C, a large amount of active components is lost or their activities are lost. From this study it was concluded that the combination of blood salvage washing and filtration produces a blood product comparable to circulating maternal blood with the exception of the fetal hemoglobin contamination.
When a decision is being made to not use blood salvage, it needs to be considered in light of the known risks associated with the alternative therapy, which is allogeneic blood. Yet, it also digs into more detail - for example, exploring washing vs nonwashing of reinfused blood and the use of partially filled bowls. These recommendations are derived from the comparison of allogeneic blood costs to perceived blood salvage cost. Blood is collected from wound drains and then either filtered or washed in an automated system before reinfusion to the patient. Autologous blood transfusion after total knee arthroplasty: A randomized, prospective study comparing predonated and postoperative salvage blood. There are four components that allow for the collection of shed surgical blood. The patients starting hematocrit, sex, age, and body weight can all influence the risk of receiving blood products.
Am J Clin Pathol 1987;88: 374— 8. A simple microaggregate filter is a screen filter and works much like a window screen. In a comparative study, 2 units of red blood cells were collected in two ways: whole blood collection and apheresis collection. Because these recommendations were developed, the cost of allogeneic blood has escalated although a better understanding has been gained of the costs associated with blood salvage. In fact, it has been demonstrated that a high percentage of patients presenting for cancer surgery have circulating tumor cells but this presence does not seem to correlate with patient survival. With these contaminants, many investigators recommend that the salvaged blood be washed before readministration.
Separation of salvaged blood components depends on the balance between densities of the various constituents of blood , the fluid flow rate, and the centrifugal forces applied in the processing bowl. The types of cases should be individualized by the institution and the surgeon performing the procedure. The centrifugal force generated by a blood salvage processor is proportional to the rotation rate of the rotor in rpm and the distance between the rotor center and the walls of the bowl. It remains unclear whether patients would benefit from the application of intraoperative or postoperative autotransfusion in certain circumstances. As blood is suctioned from the surgical field, an anticoagulant is mixed with the blood. Processing of the blood will only return red cells without the coagulation factors and platelets. Many fear this practice because of cotton fibers possibly being entrained into the blood from the sponge or possible bacterial contamination being introduced into the system via the sponge.
They include a suction line and suction tip that is used in the surgical field; suction for removal of blood from the surgical site and delivery of the blood to a collection reservoir; an anticoagulant to prevent clotting; and the collection reservoir. Because the plasma and red cell stroma and other debris have less mass than the red cells, the centrifugal force applied to them is less. The cells are then stored in a collection reservoir to await processing. Advances in understanding of tolerance of normovolemic anemia transfusion requirements in critically ill patients. Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery.