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Abstract
STUDY DESIGN Cross-sectional, modified Delphi approach. OBJECTIVE The primary objective of this study was to identify patients at risk of increased perioperative blood loss according to the opinion of expert spine surgeons across Canada. The secondary objective was to obtain information about the experts' approach on how to minimize significant blood loss perioperatively. SUMMARY OF BACKGROUND DATA Significant blood loss in major spinal surgeries has been associated with increased intra- and perioperative complications and costs. The current available evidence regarding risk factors and preventive measures for increased blood loss remains incomplete. METHODS A modified Delphi approach was employed to generate consensus opinion on the risk factors and preventive measures for significant blood loss in major spinal surgeries. Twenty-five spine surgeons in Canada participated in this study. RESULTS Among various factors, surgery for the treatment of spine tumors and prolonged operative time of greater than 5 hours were found to be the most important predictive factors for blood loss in spine surgery. On the other hand, appropriate surgical hemostasis was considered the most effective measure for the prevention of blood loss in these surgeries. CONCLUSION We recommend the reduction of blood loss by means of meticulous hemostasis and shorter operative time when it is safe and possible. This might result in better treatment outcomes. It would also lead to a reduction in costs associated with major spine surgeries and would ultimately lead to greater value-based spine care. LEVEL OF EVIDENCE 4.
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Theusinger OM, Spahn DR. Perioperative blood conservation strategies for major spine surgery. Best Pract Res Clin Anaesthesiol 2015; 30:41-52. [PMID: 27036602 DOI: 10.1016/j.bpa.2015.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/12/2015] [Accepted: 11/20/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Orthopedic surgery, especially spine and spinal deformity surgery, may be associated with high perioperative blood loss. In order to reduce the risk of excessive blood loss and unnecessary blood transfusions, strategies such as Patient Blood Management including goal-directed coagulation management have been developed. RECENT FINDINGS Adverse effects of allogeneic blood transfusions have been shown for most surgical fields including orthopedic surgery. Several efforts have been made to increase the preoperative red blood cell (RBC) mass, to reduce the intraoperative blood loss, and to use restrictive transfusion triggers in order to minimize or avoid RBC transfusions. Measures to reduce intraoperative blood loss include new surgical techniques, use of cell salvage where possible, bedside coagulation management with point-of-care devices, substitution of coagulation factors, antifibrinolytic agents, and desmopressin, induced hypotension, and avoidance of hypothermia. SUMMARY Blood conservation in spinal surgery is a multidisciplinary approach and the efficacy of most single measures has been shown. Cost-effectiveness and the benefits of long-term patient outcomes are the subjects of current and future research.
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Affiliation(s)
- Oliver M Theusinger
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland.
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
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Nobahar MR, Chegini A, Behnaz F. Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery. Saudi J Anaesth 2014; 8:342-4. [PMID: 25191183 PMCID: PMC4141381 DOI: 10.4103/1658-354x.136426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Acute normovolemic hemodilution (ANH) and preoperative autologous blood donation (PABD) have questionable efficacy, viral and bacterial infection risks, intermittent blood shortages as homeostasis problem, electrolyte and hemodynamic disturbances. Materials and Methods: In this cross sectional survey, we studied 70 patients undergoing open heart coronary artery bypass grafts [CABG] and different valvular replacement 1 ml surgery (35 in ANH, 35 in PABD) in Shaheed Modares - Hospital. We measured electrolytes and homeostatic factors to evaluate the influence of two transfusion methods on homeostatic function and hemodynamic balance. Results: We compared 70 patients (38 male [54.3%] and 32 female [45.7%]) with mean age 54.8 years undergoing open heart surgery (CABG and valvular). In ANH group, significant decrease was detected in Na (28.5%) K (2.5%), prothrombin time (PT) (88.57%), partial thromboplastin time (PTT) (94.28%), creatine phosphokinase (CPK) (11.4%), lactic dehydrogenase (LDH) (11.43%), albumin (Alb) (17.14%), globulin (91.43%) and total protein (80%). Mean initial and post-operative hemoglobin was 14.12 ± 1.06 versus 11.97 ± 0.98, hematocrit 42.22 ± 3.45 versus 35.40 ± 2.88, systolic blood pressure 124.1 ± 14.4 versus 110.88 ± 15.6 (reduction 22.86%) diastolic blood pressure 76.02 ± 10 versus 69.26 ± 11 (reduction 3%) and pulse rate was 75.45 ± 10 versus 84.45 ± 12 (12%) in this case difference between two groups was strongly significant (P = 0.001). In PABD group, significant decrease was detected in Na (20%), K (2.5%), PT (91.43%) PTT (80%), CPK (8.57%), LDH (5.72%), Alb (57.15%), globulin (71.43%) and total-protein (62.85%), the value of hemodynamic changes were in normal range. Conclusion: Though autologous blood transfusion (ANH and PABD) was preferable to allogeneic transfusion in cardiac surgical patients; but PABD offers more advantages in homeostasis, hemodynamic stability and electrolyte balance.
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Affiliation(s)
- Mohammad Rezvan Nobahar
- Department of Cardiac Anesthesia (Anesthesiology in Cardiac Surgery), Shahid Modares Hospital, Saadat Abad, Tehran, Iran
| | - Azita Chegini
- Department of Cardiac Anesthesia (Anesthesiology in Cardiac Surgery), Shahid Modares Hospital, Saadat Abad, Tehran, Iran
| | - Faranak Behnaz
- Department of Cardiac Anesthesia (Anesthesiology in Cardiac Surgery), Shahid Modares Hospital, Saadat Abad, Tehran, Iran
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Ersen O, Ekıncı S, Bılgıc S, Kose O, Oguz E, Sehırlıoglu A. Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system: a retrospective comparison. Musculoskelet Surg 2012; 96:107-110. [PMID: 22644881 DOI: 10.1007/s12306-012-0203-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 05/11/2012] [Indexed: 06/01/2023]
Abstract
This study investigates efficacy and safety of routine cell salvage system use in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion surgery with segmental spinal instrumentation. Forty-five consecutive adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by two surgeons at a single hospital were studied. Intraoperative cell salvage system was used in 23 patients, and the control group was 22 patients who underwent surgery without cell salvage system. The cell salvage system was the Haemonetics Cell Saver 5. The primary outcome measures were intraoperative and perioperative allogeneic transfusion rate, difference between preoperative and discharge Hg and Hct levels. Average patient age was 14.65 ± 1.49 in cell saver group and 13.86 ± 2.0 in control group. In cell saver group, average intraoperative autotransfusion was 382.1 ± 175 ml. Average perioperative allogeneic blood transfusion need was 1.04 ± 0.7 unit in cell saver group and 2.5 ± 1.14 unit in control group. No transfusion reactions occurred in either group. Average hemoglobin level in cell saver group was 10.7 ± 0.86 and average hemoglobin level in control group was 10.7 ± 0.82 on discharge. Cell saver reduces perioperative transfusion rate in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.
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Affiliation(s)
- Omer Ersen
- Department of Orthoapaedics and Traumatology, Gulhane Military Medical Academy, Ankara, Turkey
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Efficacy of preoperative autologous blood donation for elective posterior lumbar spinal surgery. Spine (Phila Pa 1976) 2011; 36:E1736-43. [PMID: 21992934 DOI: 10.1097/brs.0b013e3182194a42] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Evaluate the transfusion patterns associated with preoperative autologous blood donation (PABD) during posterior lumbar spinal surgery. SUMMARY OF BACKGROUND DATA There is a paucity of evidence in the literature examining the utility of PABD in elective adult lumbar spinal surgery. METHODS Medical records of 541 patients treated for spinal stenosis between January 1997 and February 2000 were reviewed. Patients were divided into donors (PABD; n = 413) and nondonors (non PABD [NPABD]; n = 128). RESULTS Average preoperative hemoglobin (Hb) in the NPABD group was 0.62 units more than in the PABD group (95% confidence interval [CI] = 0.30-0.94). For PABD patients, there was a negative correlation (-0.3) between preoperative Hb and number of units donated. PABD patients who donated 1 and 2 units of blood were, respectively, 7.5 and 9 times more likely to be transfused within the first 24 hours than NPABD patients. NPABD patients were 25 times more likely to need a transfusion of allogeneic blood than PABD patients who donated at least 2 units of blood. Autologous donation was an independent predictor of perioperative blood loss (P < 0.05). Patients who donated at least 2 units of blood lost approximately 1.3 units of Hb more than NPABD patients. The odds of wastage for a PABD patient who had a decompression with noninstrumented fusion were 8.64 times that of a PABD patient who had a decompression with instrumented fusion. CONCLUSION Autologous blood donation induced preoperative anemia and resulted in a lower transfusion threshold than allogeneic blood usage. In addition, we found that autologous donation significantly increased blood loss in the preoperative period as measured by Hb lost. Usage of autologous blood was significantly more efficient in patients who underwent instrumented fusion than in patients with less complex surgery.
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Tse EYW, Cheung WY, Ng KFJ, Luk KDK. Reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. J Bone Joint Surg Am 2011; 93:1268-77. [PMID: 21776581 DOI: 10.2106/jbjs.j.01293] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
At present, individual techniques, including intraoperative acute normovolemic hemodilution, use of tranexamic acid, use of intrathecal morphine, proper positioning, and modification of operative techniques, seem most promising for reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. Other techniques including preoperative autologous predonation; mandatory discontinuation of use of antiplatelet agents; intraoperative and postoperative red-blood-cell salvage; use of aprotinin, epsilon-aminocaproic acid, recombinant factor VIIa, or desmopressin; induced hypotension; avoidance of hypothermia; and minimally invasive operative techniques require additional studies to either establish their effectiveness or address safety considerations.
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Affiliation(s)
- Eva Y W Tse
- Department of Anesthesiology, The University of Hong Kong, Hong Kong SAR, China
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Complications in spinal deformity surgery: issues unrelated directly to intraoperative technical skills. Spine (Phila Pa 1976) 2010; 35:2215-23. [PMID: 21102296 DOI: 10.1097/brs.0b013e3181fd591f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Literature review of complications unrelated directly to surgical skills involved in spinal deformity surgery. OBJECTIVE Highlight complications associated with perioperative issues. SUMMARY OF BACKGROUND DATA Complications can arise from mundane events that arise during the operative experience, but are not directly related to surgical skills. METHODS Literature reviews that touches on the more common potential complication events that do not involve direct surgical expertise. RESULTS The topics of positioning, nutrition, blood loss, comorbidities, OR time, and pulmonary and GI concerns are discussed as basics that could derail a surgical outcome even with an otherwise uneventful surgical technique. The need for vigilance is stressed and the nuances of understanding these are discussed. CONCLUSION Mundane events can derail a perfectly executed surgical undertaking. Attention to detail, team work, close monitoring, and checklist type focus will help to improve, focus, and avoid these preventable complications that have nothing to do with direct surgical skills.
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Epstein NE. Bloodless spinal surgery: a review of the normovolemic hemodilution technique. ACTA ACUST UNITED AC 2008; 70:614-8. [DOI: 10.1016/j.surneu.2008.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 01/05/2008] [Indexed: 10/22/2022]
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Park MS, Moon SH, Kim HS, Hahn SB, Park HW, Park SY, Lee HM. A comparison of autologous and homologous transfusions in spinal fusion. Yonsei Med J 2006; 47:840-6. [PMID: 17191314 PMCID: PMC2687825 DOI: 10.3349/ymj.2006.47.6.840] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Autologous transfusion has been used to overcome adverse effects of homologous transfusion. Clinical studies evaluating general orthopaedic postoperative results have been designed to compare these transfusion methods. However, few studies have evaluated postoperative results in spinal fusion surgeries, which have larger blood loss volumes. The purpose of this study is to determine if there are differences in postoperative infection and clinical results of spinal fusion with autologous, as compared to homologous, blood transfusion. A total of 62 patients who underwent instrumented spinal fusion and received autologous (n = 30) or homologous (n = 32) transfusions were reviewed. Information on gender, age, preoperative and 3-day postoperative hematologic features, total transfused units, segmental estimated blood loss, transfused units, and surgery time were collected. In addition, postoperative infection data on wound infection, pneumonia, urinary tract infection, cellulitis, and viral disease, incidence and duration of fever, as well as clinical results, fusion rates, and patient feedback were collected. No differences in postoperative infection and clinical results were found between the two types of transfusions; however, homologous transfusion was associated with an increased number of total units transfused, longer duration of fever, and decreased patient satisfaction regarding the transfusion.
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Affiliation(s)
- Moon-Soo Park
- Department of Orthopaedic Surgery, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hak-Sun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Bong Hahn
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Wan Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Si-Young Park
- Department of Orthopaedic Surgery, Korea University, Anam Hospital, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Epstein NE, Peller A, Korsh J, DeCrosta D, Boutros A, Schmigelski C, Greco J. Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion. Spine (Phila Pa 1976) 2006; 31:2227-30; discussion 2231. [PMID: 16946658 DOI: 10.1097/01.brs.0000232703.59829.ac] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN To determine whether the normovolemic hemodilution (NH) technique would limit postoperative homologous blood transfusion requirements in 68 patients having multilevel lumbar laminectomies (3-6 levels) with predominant 1- or 2-level instrumented fusions. OBJECTIVE In this setting, to define postoperative homologous blood transfusion requirements using NH. SUMMARY OF BACKGROUND DATA NH limits postoperative homologous blood transfusion requirements following various types of surgical procedures including those on the spine. METHODS NH was used in an attempt to limit postoperative homologous transfusion requirements in 68 patients undergoing lumbar surgery. NH involves the removal of 1 to 2 U of blood replaced with crystalloid (2-4 mL per milliliter of blood harvested). Multiple variables contributing to homologous transfusion requirements were analyzed. RESULTS Using NH, no homologous blood transfusions were required in 52 patients with a mean preoperative hematocrit of 41.3 undergoing average 3.7 level laminectomies with 1.5 level fusions. However, 16 patients with an average preoperative hematocrit of 38.5 undergoing average 4.3 level laminectomies with 1.6 level fusions required transfusion of 31 U of homologous blood after surgery. CONCLUSIONS Using NH, 16 (23.5%) patients required 31 postoperative homologous blood transfusions. By contrast, the remaining 52 patients with similar procedures were able to avoid the use of homologous transfusion.
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Affiliation(s)
- Nancy E Epstein
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
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García-Erce JA, Muñoz M, Bisbe E, Sáez M, Solano VM, Beltrán S, Ruiz A, Cuenca J, Vicente-Thomas J. Predeposit autologous donation in spinal surgery: a multicentre study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2004; 13 Suppl 1:S34-9. [PMID: 15241669 PMCID: PMC3592186 DOI: 10.1007/s00586-004-0726-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Accepted: 04/02/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Allogeneic blood transfusions (ABT) are often necessary in elective spine surgery because of perioperative blood loss. Preoperative autologous blood donation (PABD) has emerged as the principal means to avoid or reduce the need for ABT. Consequently, a multicentre study was conducted to determine the yield and efficacy of PABD in spine surgery and the possible role of recombinant human erythropoietin (EPO) in facilitating PABD. METHODS We retrospectively reviewed the hospital charts and blood bank records from all consecutive spine surgery patients who were referred for PABD. Data were obtained from two A-category hospital blood banks and one general hospital. Although we collected data from 1994, the analytic study period was from the last quarter of 1995 to December 2003. Fifty-four (7%) out of 763 patients referred for PABD were rejected, and medical records were available for 680 patients who were grouped into spinal fusion (556; 82%) and scoliosis surgery (124;18%). EPO was administered to 120 patients (17.6%). From 1999 to 2003, PABD steadily increased from 60 to 209 patients per year. RESULTS Overall, 92% of the patients were able to complete PABD, 71% were transfused, and almost 80% avoided ABT. PABD was more effective in fusions (86%) than in scoliosis (47%). Blood wastage was 38%, ranging from 18% for scoliosis to 42% for fusions. EPO allowed the results in the anaemic patients to be improved. CONCLUSIONS Therefore, despite the limitations of this retrospective study, we feel that PABD is an excellent alternative to ABT in spine surgery. However, the effectiveness of PABD may be enhanced if associated with other blood-saving techniques.
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Affiliation(s)
- José A García-Erce
- Department of Haematology and Haemotherapy, Hospital Universitario Miguel Servet, Paseo Isabel La Católica 1, 50009 Zaragoza, Spain.
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Epstein NE, Peller A, Boutros A, Koreff J, DeCrosta D, Schmigelski C, Greco J. Normovolemic Hemodilution:. ACTA ACUST UNITED AC 2004. [DOI: 10.2531/spinalsurg.18.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nancy E. Epstein
- The Albert Einstein College of Medicine
- Attending in Neurosurgery, Winthrop University Hospital
| | - Abraham Peller
- Attending Department of Anesthesia, Winthrop University Hospital
| | - Ashray Boutros
- Attending Department of Anesthesia, Winthrop University Hospital
- State University of New York
| | - Jeff Koreff
- Attending Department of Anesthesia, Winthrop University Hospital
- State University At Stony Brook
| | - Don DeCrosta
- Attending Department of Anesthesia, Winthrop University Hospital
- State University At Stony Brook
| | - Carl Schmigelski
- Attending Department of Anesthesia, Winthrop University Hospital
| | - Joseph Greco
- Attending Department of Anesthesia, Winthrop University Hospital
- State University of New York
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Blais RE, Hadjipavlou AG, Shulman G. Efficacy of autotransfusion in spine surgery: comparison of autotransfusion alone and with hemodilution and apheresis. Spine (Phila Pa 1976) 1996; 21:2795-800. [PMID: 8979328 DOI: 10.1097/00007632-199612010-00016] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Two prospective groups of patients received intraoperative autologous transfusion during reconstructive spine surgery. Before intraoperative autologous transfusion, one group underwent normovolemic hemodilution and apheresis of blood components in the operating room while being prepared for surgery. The allogeneic blood products needed for transfusion by each group were studied and compared with those of a retrospective group of patients receiving conventional transfusion therapy. OBJECTIVES To determine if a combination of intraoperative autologous transfusion and hemodilution and apheresis decreases reliance on allogeneic blood products and increases autologous transfusions. SUMMARY OF BACKGROUND DATA Transfusion rates of allogeneic red blood cells, which were unchanged by intraoperative autologous transfusion alone, were lowered when treatment included transfusion of these cells and preoperative autologous deposit. However, donor exposures from transfusions of allogeneic platelets and fresh frozen plasma have not been addressed. METHOD Preoperative hemodilution and apheresis of autologous red blood cells, fresh plasma, and platelets, performed during induction of anesthesia for spine surgery was followed by intraoperative autologous transfusion using the same supplies. Intra- and postoperative transfusion of blood products to each group were evaluated and compared; allogeneic transfusions were given to a retrospective cohort of patients who received conventional transfusion therapy. RESULTS Hemodilution and apheresis followed by intraoperative autologous transfusion reduced exposures to individual blood donor products resulting in fewer transfusions and in transfusion of significantly fewer blood products. Intraoperative autologous transfusion alone decreased the number of red blood cells transfused, but required the same donor exposures for fresh frozen plasma and platelet support as the cohort of patients who received conventional transfusion therapy. CONCLUSIONS A combination of hemodilution and apheresis and intraoperative autologous transfusion significantly decreased transfusion of allogeneic blood products and reliance on preoperative autologous deposit. Autologous transfusion of all blood products was significantly increased.
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Affiliation(s)
- R E Blais
- Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, USA
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Heath KJ, McFadzean WA. Acute respiratory distress syndrome following autotransfusion with the Biosurge autotransfuser. J ROY ARMY MED CORPS 1995; 141:105-6. [PMID: 7562735 DOI: 10.1136/jramc-141-02-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A case of acute respiratory distress syndrome in a 79-year-old man is presented in which the use of a BioSurge synchronous autotransfuser may be implicated. This has not been reported before.
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Affiliation(s)
- K J Heath
- Department of Anaesthetics, Cambridge Military Hospital, Aldershot, Hants
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