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Ward L. Leveraging Clinical Ladder Nurses to Support an Education Program on Intraoperative Cell Salvage for Obstetric Patients. AORN J 2024; 119:143-151. [PMID: 38275255 DOI: 10.1002/aorn.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 01/27/2024]
Abstract
Postpartum hemorrhage continues to be a leading cause of maternal morbidity and mortality in the United States. With the use of appropriate screening tools and treatment modalities, most of these deaths are preventable. Various interventions are used to prevent and treat postpartum hemorrhage, though intraoperative cell salvage historically has been contraindicated in the obstetric setting. This article explores the implementation of intraoperative cell salvage in the obstetric setting at two campuses of a health care system with the assistance of nurses participating in a professional nurses advancement program (ie, a clinical ladder). The initiative comprised a literature review, interdisciplinary collaboration, and education planning and execution. The educational approach focused on adult learners and included both self-directed and instructor-led elements. Including clinical nurses in clinical education is beneficial because they are highly motivated to share evidence-based practice with their peers to elevate patient safety and quality measures, making them ideal education partners.
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Sam AM, Nair AR, Gupta D. Autologous blood transfusion in a neurosurgical patient with multiple alloantibodies. Asian J Transfus Sci 2023; 17:276-278. [PMID: 38274966 PMCID: PMC10807522 DOI: 10.4103/ajts.ajts_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/21/2022] [Accepted: 05/29/2022] [Indexed: 01/27/2024] Open
Abstract
There are many challenges to obtain antigen-negative, crossmatch compatible blood for a patient with multiple alloantibodies. We present a case report of a 31-year-old female patient with a recurrent pontine cavernoma who was to undergo a neurosurgical procedure. We identified alloantibodies anti-Fya and anti-c in her blood sample. To meet her intraoperative blood requirement, we attempted with autologous blood transfusion using both predeposit autologous donation and acute normovolemic hemodilution. Autologous blood alone was sufficient despite anticipating surgical blood loss and a postoperative surgical site infection.
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Affiliation(s)
- Angel Mary Sam
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Amita Radhakrishnan Nair
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Debasish Gupta
- Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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3
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Zhou X, Xu L, Chang X, Sun L, Guo Z. Blood protection of autologous platelet-rich plasma in long-time aortic root reconstruction: A retrospective study. Perfusion 2023:2676591231177900. [PMID: 37201917 DOI: 10.1177/02676591231177900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study aimed to investigate the blood protective effect of autologous platelet-rich plasma in aortic root reconstruction under longtime cardiopulmonary bypass. METHOD Patients who underwent aortic root reconstruction between August 2018 and August 2022 were included and divided into experimental and control groups according to whether autologous platelet-rich plasmapheresis was used or not. The experimental group included 112 patients (90 males aged 39.00 [28.75-49.00] years), and the control group included 112 patients (90 males aged 37.00 [27.00-46.25] years). The clinical data for example EuroSCORE II cardiovascular surgery risk score, blood routine and other indicators were collected from the two groups. RESULTS The transfusion volume of allogeneic red blood cells in the experimental group (52 cases without blood transfusion, 23 cases with 1-2 units, 15 cases with 3-4 units, and 22 cases with 5 units and above) was significantly lower than that in the control group (32 cases without transfusion, 34 cases with 1-2 units, 22 cases with 3-4 units, and 24 cases with 5 units or more) (Z = -2.06, p < 0.05). Resternotomy/thoracotomy occurred in 11 cases (9.8%) in the experimental group and 23 cases (20.5%) in the control group (RR = 2.37, 95% CI: 1.1-5.14, p < 0.05). The number of bleeding events in the experimental group (18 cases, 16.1%) was significantly less than that in the control group (33 cases, 29.5%) (RR = 2.18, 95% CI: 1.14-4.17, p < 0.05). CONCLUSIONS The application of autologous platelet-rich plasma in a long-time cardiopulmonary bypass aortic root reconstruction can reduce the amount of allogeneic blood transfusion and the occurrence of bleeding events, which is beneficial for blood protection.
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Affiliation(s)
- Xiaoyu Zhou
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Lingfeng Xu
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Xin Chang
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Lin Sun
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Zhen Guo
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
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4
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Okazaki T, Imagama T, Tanaka H, Shiigi E, Hirata K, Kaneoka T, Kawakami T, Sakai T. Comparison of simultaneous versus staged bilateral total hip arthroplasty via the direct anterior approach: A propensity score matched analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231180328. [PMID: 37340640 DOI: 10.1177/10225536231180328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
PURPOSE It remains unclear whether simultaneous bilateral total hip arthroplasty (SimBTHA) or staged bilateral total hip arthroplasty (StaBTHA) is clinically superior. No study has compared these two procedures matching surgical approach and patient background. This study aimed to clarify the differences between SimBTHA using direct anterior approach (SimBTHA-DAA) and StaBTHA using the direct anterior approach (StaBTHA-DAA). METHODS Patients who underwent THA between 2012 and 2020 were enrolled, resulting in a total of 1658 hips of 1388 patients. After propensity score matching for patient background, 204 hips of 102 patients (51 patients in each group) were examined. Clinical and radiographic outcomes, complications, intraoperative blood loss and blood transfusions (BT) were evaluated. In complications, we evaluated periprosthetic fractures, pulmonary embolism, deep venous thrombosis, surgical site infection and dislocation. RESULTS At the final follow-up, clinical and radiographic outcomes and complications were not significantly different between the groups. Intraoperative blood loss was equivalent for SimBTHA and the sum in the first- and second-stage StaBTHA. The total-BT rate was significantly higher for SimBTHA-DAA than for StaBTHA-DAA (p < .0001). The allogeneic BT rate was significantly higher in SimBTHA-DAA in the supine position (32.3%) than in StaBTHA-DAA (8.3%) (p = .007). However, no patient who received autologous BT required allogeneic BT. CONCLUSIONS Clinical and radiographic outcomes were equivalent between SimBTHA-DAA and StaBTHA-DAA. The allogeneic BT rate was significantly higher in SimBTHA-DAA than in StaBTHA-DAA. Autologous BT reduced the use of allogeneic BT in SimBTHA-DAA. Auto-BT may be useful for avoiding allo-BT in SimBTHA.
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Affiliation(s)
- Tomoya Okazaki
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroshi Tanaka
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Eiichi Shiigi
- Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Kenji Hirata
- Department of Orthopedic Surgery, Shuto General Hospital, Yanai, Japan
| | - Takehiro Kaneoka
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takehiro Kawakami
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Garifulin R, Davleeva M, Izmailov A, Fadeev F, Markosyan V, Shevchenko R, Minyazeva I, Minekayev T, Lavrov I, Islamov R. Evaluation of the Autologous Genetically Enriched Leucoconcentrate on the Lumbar Spinal Cord Morpho-Functional Recovery in a Mini Pig with Thoracic Spine Contusion Injury. Biomedicines 2023; 11:biomedicines11051331. [PMID: 37239001 DOI: 10.3390/biomedicines11051331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Pathological changes associated with spinal cord injury (SCI) can be observed distant, rostral, or caudal to the epicenter of injury. These remote areas represent important therapeutic targets for post-traumatic spinal cord repair. The present study aimed to investigate the following in relation to SCI: distant changes in the spinal cord, peripheral nerve, and muscles. METHODS The changes in the spinal cord, the tibial nerve, and the hind limb muscles were evaluated in control SCI animals and after intravenous infusion of autologous leucoconcentrate enriched with genes encoding neuroprotective factors (VEGF, GDNF, and NCAM), which previously demonstrated a positive effect on post-traumatic restoration. RESULTS Two months after thoracic contusion in the treated mini pigs, a positive remodeling of the macro- and microglial cells, expression of PSD95 and Chat in the lumbar spinal cord, and preservation of the number and morphological characteristics of the myelinated fibers in the tibial nerve were observed and were aligned with hind limb motor recovery and reduced soleus muscle atrophy. CONCLUSION Here, we show the positive effect of autologous genetically enriched leucoconcentrate-producing recombinant neuroprotective factors on targets distant to the primary lesion site in mini pigs with SCI. These findings open new perspectives for the therapy of SCI.
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Affiliation(s)
- Ravil Garifulin
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Maria Davleeva
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Andrei Izmailov
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Filip Fadeev
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Vage Markosyan
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Roman Shevchenko
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Irina Minyazeva
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Tagir Minekayev
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Igor Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rustem Islamov
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
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Bai Y, Liu T, Cui YH, Li ZZ, Zhou XF, Cheng Y, Wang JH, Guo JR. Autologous blood transfusion promotes autophagy and inhibits hepatocellular carcinoma progression through HIF-1α signalling pathway. J Cell Mol Med 2023; 27:1353-1361. [PMID: 37038623 PMCID: PMC10183710 DOI: 10.1111/jcmm.17736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023] Open
Abstract
To explore the molecular mechanism of autologous blood transfusion promoting autophagy of hepatocellular carcinoma (HCC) cells and inhibiting the HCC progression through HIF-1α signalling pathway. This is a research paper. Rat hepatocellular carcinoma model and HepG2 cell model were built. The rats with HCC were conducted a surgery, and their blood was collected for detection to detect the recurrence and metastasis of the rats. Western blot was used to analysed the expression of HIF-1α, TP53, MDM2, ATG5 and ATG14 protein. The apoptosis rate of HepG2 cells was detected by flow cytometry, and autophagosomes were observed by transmission electron microscopy. HIF-1α expression was measured by immunofluorescence assay. The expressions of HIF-1α, TP53, MDM2, ATG5 and ATG14 protein were highest in model + autoblood group compared with the model group. HIF-1α content of model group was higher, but content of TP53, MDM2, ATG5 and ATG14 in the model group is the second. The highest apoptosis rate was found in HepG2 + autoblood group. The number of autophagosomes in HepG2 + autoblood was obviously larger than that of HepG2 + autoblood + inhibitor. HIF-1α expression of immunofluorescence assay showed that high expression of HIF-1α was clearly observed in HepG2 and HepG2 + autoblood group from confocal observation. However, there was no HIF-1α protein expression in HepG2 + autoblood + inhibitor group. The migration rate in HepG2 group, HepG2 + autoblood group and HepG2 + autoblood + inhibitor group was 85.71 ± 7.38%, 14.36 ± 6.54% and 61.25 ± 5.39%, respectively. Autologous blood transfusion promotes autophagy of HCC cells through HIF-1α signalling pathway, which further inhibits HCC migration and erosion.
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Affiliation(s)
- Yu Bai
- Graduate School of Wannan Medical College, Wuhu, Anhui, China
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Tong Liu
- Graduate School of Wannan Medical College, Wuhu, Anhui, China
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Ying-Hui Cui
- Graduate School of Wannan Medical College, Wuhu, Anhui, China
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Zhen-Zhou Li
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Xiao-Fang Zhou
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Yong Cheng
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Jin-Huo Wang
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Jian-Rong Guo
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
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7
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van Baarle FLF, de Bruin S, Bulle EB, van Mourik N, Lim EHT, Tuip-de Boer AM, Bongers A, de Wissel MB, van Bruggen R, de Korte D, Vermeulen C, Tan KW, Jonkers RE, Bonta PI, Lutter R, Dekker T, Dierdorp BS, Peters AL, Biemond BJ, Vlaar APJ. Aged versus fresh autologous platelet transfusion in a two-hit healthy volunteer model of transfusion-related acute lung injury. Transfusion 2022; 62:2490-2501. [PMID: 36300793 PMCID: PMC10092071 DOI: 10.1111/trf.17157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a severe complication of blood transfusion that is thought of as a two-hit event: first the underlying patient condition (e.g., sepsis), and then the transfusion. Transfusion factors include human leukocyte antigen antibodies or biologic response modifiers (BRMs) accumulating during storage. Preclinical studies show an increased TRALI risk with longer stored platelets, clinical studies are conflicting. We aim to discover whether longer platelet concentrate (PC) storage time increases TRALI risk in a controlled human experiment. STUDY DESIGN AND METHODS In a randomized controlled trial, 18 healthy male volunteers received a first hit of experimental endotoxemia (2 ng/kg lipopolysaccharide), and a second hit of fresh (2-day old) or aged (7-day old) autologous PC, or physiological saline. After 6 h, changes in TRALI pathways were determined using spirometry, chest X-ray, and bronchoalveolar lavage (BAL). RESULTS All subjects reacted adequately to lipopolysaccharide infusion and satisfied SIRS criteria (increased pulse [>90/min] and temperature [>38°C]). There were no differences between the saline, fresh, and aged PC groups in BAL-fluid protein (95 ± 33 μg/ml; 83 ± 21 μg/ml and 104 ± 29 μg/ml, respectively) and relative neutrophil count (1.5 ± 0.5%; 1.9 ± 0.8% and 1.3 ± 0.8%, respectively), nor in inflammatory BAL-fluid BRMs (Interleukin-6, CXCL8, TNFα , and myeloperoxidase), clinical respiratory parameters, and spirometry results. All chest X-rays were normal. CONCLUSIONS In a human endotoxemia model of autologous platelet transfusion, with an adequate first hit and platelet storage lesion, transfusion of 7-day-old PC does not increase pulmonary inflammation compared with 2-day-old PC.
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Affiliation(s)
- Floor L F van Baarle
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne de Bruin
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Esther B Bulle
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Niels van Mourik
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Endry H T Lim
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anita M Tuip-de Boer
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Annabel Bongers
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marit B de Wissel
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Dirk de Korte
- Department of Blood Cell Research, Sanquin Blood Supply, Amsterdam, The Netherlands.,Department of Product and Process Development, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Christie Vermeulen
- Department of Product and Process Development, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Khik Wie Tan
- Sanquin Blood Bank Location Leiden, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - René E Jonkers
- Department of Respiratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - René Lutter
- Department of Respiratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, Amsterdam, The Netherlands
| | - Tamara Dekker
- Department of Experimental Immunology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara S Dierdorp
- Department of Experimental Immunology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anna L Peters
- Department of Anesthesiology, UMC Utrecht, Utrecht, The Netherlands
| | - Bart J Biemond
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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Norton EL, Kim KM, Fukuhara S, Monaghan KP, Naeem A, Wu X, Ailawadi G, Patel HJ, Deeb GM, Yang B. Autologous blood transfusion in acute type A aortic dissection decreased blood product consumption and improved postoperative outcomes. JTCVS Open 2022; 12:20-29. [PMID: 36590717 PMCID: PMC9801237 DOI: 10.1016/j.xjon.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 06/02/2022] [Accepted: 06/22/2022] [Indexed: 01/04/2023]
Abstract
Objective To evaluate the effect of autologous blood use on blood product consumption and outcomes after acute type A aortic dissection repair. Methods From 2010 to October 2020, 497 patients underwent open acute type A aortic dissection repair, including those with autologous blood harvesting before cardiopulmonary bypass and transfusion after cardiopulmonary bypass (autologous blood transfusion [ABT], n = 397) and without autologous blood harvesting and transfusion (No-ABT, n = 100). The median ABT volume was 900 mL. Using propensity score matching, 89 matched pairs were identified based on age, sex, body mass index, preoperative hemoglobin, acute preoperative stroke, previous cardiac surgery, and cardiogenic shock. Results After propensity score matching, both groups were similar in demographic characteristics and aortic procedures. The ABT group required significantly less intraoperative transfusion of blood products (6 vs 11 units; P < .0001), including packed red blood cells (2 vs 4), fresh frozen plasma (2 vs 4), platelets (2 vs 2), and cryoprecipitate (0 vs 1); and combined intraoperative and postoperative transfusion (9 vs 13; P < .001). ABT was protective against intra- and postoperative blood product transfusion (odds ratio, 0.28; P = .01). The ABT group had significantly less sepsis, acute renal failure requiring dialysis, reintubation, and shorter intubation times and postoperative lengths of stay. Operative mortality was 6.7% in the ABT group versus 13% in the No-ABT group (P = .14). The midterm survival was similar between the 2 groups (5 year: 76% vs 74%). ABT had a hazard ratio of 0.81 for midterm mortality (P = .41). Conclusions Autologous blood transfusion was associated with better short-term outcomes and could be used routinely for acute type A aortic dissection repair. External multicenter prospective validation would be warranted.
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Affiliation(s)
- Elizabeth L. Norton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Karen M. Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | | | | | - Aroma Naeem
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | | | - G. Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich,Address for reprints: Bo Yang, MD, PhD, Department of Cardiac Surgery, Michigan Medicine, 5155 Frankel Cardiovascular Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
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9
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Sugasawa T, Kanki Y, Komine R, Watanabe K, Takekoshi K. Identification of RNA Markers in Red Blood Cells for Doping Control in Autologous Blood Transfusion. Genes (Basel) 2022; 13:genes13071255. [PMID: 35886040 PMCID: PMC9317427 DOI: 10.3390/genes13071255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
The World Anti-Doping Agency (WADA) has prohibited the use of autologous blood transfusion (ABT) as a doping method by athletes. It is difficult to detect this doping method in laboratory tests, and a robust testing method has not yet been established. We conducted an animal experiment and used total RNA sequencing (RNA-Seq) to identify novel RNA markers to detect ABT doping within red blood cells (RBCs) as a pilot study before human trials. This study used whole blood samples from Wistar rats. The whole blood samples were mixed with a citrate–phosphate–dextrose solution with adenine (CPDA) and then stored in a refrigerator at 4 °C for 0 (control), 10, or 20 days. After each storage period, total RNA-Seq and bioinformatics were performed following RNA extraction and the purification of the RBCs. In the results, clear patterns of expression fluctuations were observed depending on the storage period, and it was found that there were large numbers of genes whose expression decreased in the 10- and 20-day periods compared to the control. Moreover, additional bioinformatic analysis identified three significant genes whose expression levels were drastically decreased according to the storage period. These results provide novel insights that may allow future studies to develop a testing method for ABT doping.
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Affiliation(s)
- Takehito Sugasawa
- Laboratory of Clinical Examination and Sports Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan; (T.S.); (Y.K.)
- Department of Sports Medicine Analysis, Open Facility Network Office, Organization for Open Facility Initiatives, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan;
| | - Yasuharu Kanki
- Laboratory of Clinical Examination and Sports Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan; (T.S.); (Y.K.)
- Department of Sports Medicine Analysis, Open Facility Network Office, Organization for Open Facility Initiatives, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan;
| | - Ritsuko Komine
- Department of Sports Medicine Analysis, Open Facility Network Office, Organization for Open Facility Initiatives, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan;
- Doctoral Program in Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
| | - Koichi Watanabe
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8574, Japan;
| | - Kazuhiro Takekoshi
- Laboratory of Clinical Examination and Sports Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan; (T.S.); (Y.K.)
- Correspondence: ; Tel.: +81-29-853-3209
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10
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Amorim CS, Moraes JA, Magdalena IDJ, López SG, Carneiro ACD, Nunes IKDC, Pizzatti L, Sardela VF, Aquino Neto FR, Mirotti LC, Pereira HMG, Renovato-Martins M. Extracellular Vesicles From Stored Red Blood Cells Convey Heme and Induce Spic Expression on Human Monocytes. Front Immunol 2022; 13:833286. [PMID: 35663938 PMCID: PMC9157768 DOI: 10.3389/fimmu.2022.833286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Carolinne Souza Amorim
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Laboratório de Biologia Redox, Programa de Pesquisa em Farmacologia e Inflamação, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - João Alfredo Moraes
- Laboratório de Biologia Redox, Programa de Pesquisa em Farmacologia e Inflamação, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ingrid de Jesus Magdalena
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Sheila Gutiérrez López
- Laboratório de Biologia Molecular e Proteômica do Sangue-Laboratório de Apoio ao Desenvolvimento Tecnológico (LABMOPS-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Ana Carolina Dudenhoeffer Carneiro
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Isabelle Karine da Costa Nunes
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Luciana Pizzatti
- Laboratório de Biologia Molecular e Proteômica do Sangue-Laboratório de Apoio ao Desenvolvimento Tecnológico (LABMOPS-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Vinícius Figueiredo Sardela
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Francisco Radler Aquino Neto
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Luciana Cristina Mirotti
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Henrique Marcelo Gualberto Pereira
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mariana Renovato-Martins
- Laboratório Brasileiro de Controle de Dopagem-Laboratório de Apoio ao Desenvolvimento Tecnológico (LBCD-LADETEC), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Laboratório de Inflamação e Metabolismo, Departamento de Biologia Celular e Molecular, Instituto de Biologia, Universidade Federal Fluminense, Niterói, Brazil
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11
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Bosboom JJ, Klanderman RB, Terwindt LE, Bulle EB, Wijnberge M, Eberl S, Driessen AH, Winkelman TA, Geerts BF, Veelo DP, Hollmann MW, Vlaar APJ. Autologous red blood cell transfusion does not result in a more profound increase in pulmonary capillary wedge pressure compared to saline in critically ill patients: A randomized crossover trial. Vox Sang 2022; 117:1035-1042. [PMID: 35560234 PMCID: PMC9540110 DOI: 10.1111/vox.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Background and Objectives Transfusion‐associated circulatory overload (TACO) is a major cause of severe transfusion‐related morbidity. Transfusion of red blood cells (RBCs) has been shown to induce hydrostatic pressure overload. It is unclear which product‐specific factors contribute. We set out to determine the effect of autologous RBC transfusion versus saline on pulmonary capillary wedge pressure (PCWP) change. Materials and Methods In a randomized crossover trial, patients who had undergone coronary bypass surgery were allocated to treatment post‐operatively in the intensive care unit with either an initial 300 ml autologous RBC transfusion (salvaged during surgery) or 300 ml saline infusion first, followed by the other. Primary outcome was the difference in PCWP change. Secondary outcome measures were the difference in extra‐vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). Results Change in PCWP was not higher after autologous RBC transfusion compared to saline (ΔPCWP 0.3 ± 0.4 vs. 0.1 ± 0.4 mmHg). ΔEVLWI and ΔPVPI were significantly decreased after autologous RBC transfusion compared to saline (ΔEVLWI −1.6 ± 0.6 vs. 0.2 ± 0.4, p = 0.02; ΔPVPI −0.3 ± 0.1 vs. 0.0 ± 0.1, p = 0.01). Haemodynamic variables and colloid osmotic pressure were not different for autologous RBC transfusion versus saline. Conclusion Transfusion of autologous RBCs did not result in a more profound increase in PCWP compared to saline. RBC transfusion resulted in a decrease of EVLWI and PVPI compared to saline. Our data suggest that transfusing autologous RBCs may lead to less pulmonary oedema compared to saline. Future studies with allogeneic RBCs are needed to investigate other factors that may mediate the increase of PCWP, resulting in TACO.
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Affiliation(s)
- Joachim J Bosboom
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert B Klanderman
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte E Terwindt
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther B Bulle
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marije Wijnberge
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne Eberl
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoine H Driessen
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Toon A Winkelman
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Denise P Veelo
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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12
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Tomura J, Morikawa D, Nozawa M, Ishijima M, Kim SG. Effects of Pre-Donated Autologous Blood Transfusion on Peri-Operative Hemoglobin Concentration and Mid-Term Health Outcomes in Primary Total Knee Arthroplasty. J Clin Med 2022; 11:2252. [PMID: 35456344 DOI: 10.3390/jcm11082252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 01/28/2023] Open
Abstract
The effects of auto-BT in primary TKA on the perioperative hemoglobin (Hb) concentration and mid-term health outcomes are unknown. This study was performed to analyze the detailed changes in the perioperative Hb concentration before and after the operation (days 0–14 postoperatively), cardiovascular events, and mortality rate within 1 and 5 years postoperatively. One hundred patients undergoing primary TKA with auto-BT using 800 mL of preoperatively collected blood at the authors’ institution were included. The mean Hb concentration before and after autologous blood collection was 12.7 ± 1.1 and 11.7 ± 1.2 g/dL, respectively. After primary TKA with auto-BT, the mean Hb concentration on day 0, 1, 3, 7, and 14 was 10.2 ± 1.2, 9.9 ± 1.2, 10.4 ± 1.3, 10.5 ± 1.3, and 11.0 ± 1.3 g/dL, respectively. Only one (1%) patient required additional allogenic blood transfusion. No patients developed cardiovascular events, and the 1- and 5-year postoperative mortality rate was 1.0% and 2.0%, respectively. Primary TKA with auto-BT showed relatively small perioperative changes in the Hb concentration, a low incidence of cardiovascular events, and a low mortality rate within 1 and 5 years postoperatively. These findings suggest that auto-BT, in which blood is preoperatively collected, is beneficial for patient safety and health, even if its cost-effectiveness may be debatable.
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13
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Liao YQ, Zhang MQ. Acute air embolism caused by autotransfusion during percutaneous atrial septal defect closure: A case report. Clin Case Rep 2022; 10:e05654. [PMID: 35356172 PMCID: PMC8958190 DOI: 10.1002/ccr3.5654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 02/05/2023] Open
Abstract
Atrial septal defect is a common congenital heart disease in adults and it is often asymptomatic. Percutaneous device closure is gaining popularity, but percutaneous repair of atrial septal defect leading to left atrial rupture and subsequent autotransfusion under high pressure leading to air embolism has not been reported yet.
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Affiliation(s)
- Yu-Qi Liao
- Department of Anesthesiology The Third People's Hospital of Chengdu Chengdu China
| | - Meng-Qiu Zhang
- Department of Anesthesiology West China Hospital Sichuan University Chengdu China
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14
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Sun L, Xu Y, Huang L. Impact of Intraoperative Salvaged Blood Autotransfusion During Obstetric Hemorrhage on the Coagulation Function: A Retrospective Cohort Analysis. Clin Appl Thromb Hemost 2021; 27:10760296211064276. [PMID: 34870482 PMCID: PMC8652179 DOI: 10.1177/10760296211064276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective This study aimed to explore the effect of intraoperative blood salvage (autotransfusion) on coagulation function in the rescue of an obstetric hemorrhage. Methods A total of 65 pregnant women who were diagnosed with placenta previa in our Hospital and gave birth in the hospital were enrolled in the study. All the patients underwent thromboelastography, routine blood tests, and blood coagulation series + D-dimer before and within 30 min of the autologous blood transfusion. The differences in various indicators were evaluated. Results (1) After the autotransfusion, the hemoglobin and neutrophil counts were significantly higher than beforehand, and the platelet count was significantly reduced; the differences were statistically significant (p < .05). (2) There were no significant differences in prothrombin time (PT), fibrinogen, and D-dimer levels before and after the autotransfusion (p > .05). The activated partial thromboplastin time after autotransfusion was shorter than that beforehand, and the difference was statistically significant (p < .05). (3) There were no significant differences in the R value, K value, α value, and MA value of the thromboelastogram before and after the autotransfusion (p > .05). Conclusion After the recovery autotransfusion, the hemoglobin of patients with a massive obstetric hemorrhage increased significantly, while the platelet count decreased, but the coagulation function and thromboelastogram did not change significantly, indicating the autotransfusion did not affect the coagulation function of the obstetric hemorrhage rescue. Thus, it would appear that intraoperative blood salvage can be safely used in the clinical rescue of massive hemorrhaging during cesarean section.
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Affiliation(s)
- Ling Sun
- Department of Obstetrics, Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Ying Xu
- Department of Obstetrics, Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Lingfei Huang
- Department of Obstetrics, Taizhou Hospital of Zhejiang Province, Taizhou, China
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15
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Mladinov D, Eudailey KW, Padilla LA, Norman JB, Leahy B, Enslin J, Parker K, Cornelius KF, Davies JE. Effects of acute normovolemic hemodilution on post-cardiopulmonary bypass coagulation tests and allogeneic blood transfusion in thoracic aortic repair surgery: An observational cohort study. J Card Surg 2021; 36:4075-4082. [PMID: 34431128 DOI: 10.1111/jocs.15943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/22/2021] [Accepted: 08/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM Perioperative blood transfusion is associated with increased morbidity and mortality. Acute normovolemic hemodilution (ANH) is a blood conservation strategy associated with variable success, and rarely studied in more complex cardiac procedures. The study aim was to evaluate whether ANH improves coagulopathy and reduces blood transfusions in thoracic aortic surgeries. METHODS Single-center observational cohort study comparing ANH and standard institutional practice in patients who underwent thoracic aortic repair with cardiopulmonary bypass (CPB) from 2019 to 2021. RESULTS A total of 89 patients underwent ANH and 116 standard practice. There were no significant differences between the groups in terms of demographic or major perioperative characteristics. In the ANH group coagulation tests before and after transfusion of autologous blood showed decreased INR and increased platelets, fibrinogen, all with p < 0.0005. Coagulation results in the ANH and control groups were not statistically different. The average number of transfused allogeneic products per patient was lower in the ANH versus control group: FFP 1.1 ± 1.6 versus 1.9 ± 2.3 (p = 0.003), platelets 0.6 ± 0.8 versus 1.2 ± 1.3 (p = 0.0008), and cryoprecipitate 0.3 ± 0.7 versus 0.7 ± 1.1 (p = 0.008). Reduction in red blood cell transfusion was not statistically significant. The percentage of patients who received any transfusion was 53.9% in ANH and 59.5% in the control group (p = 0.42). There was no significant difference in major adverse outcomes. CONCLUSIONS ANH is a safe blood conservation strategy for surgical repairs of the thoracic aorta. Laboratory data suggests ANH can improve some coagulation values after separation from CPB, and significantly reduce the number of transfused FFP, platelets and cryoprecipitate.
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Affiliation(s)
- Domagoj Mladinov
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luz A Padilla
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph B Norman
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin Leahy
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jacob Enslin
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Keli Parker
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine F Cornelius
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James E Davies
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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16
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Amanvermez Senarslan D, Yildirim F, Kurdal AT, Damar A, Ozturk T, Tetik O. Efficacy and cost-effectiveness of cell saver usage in the repair of thoracic aortic aneurysms and dissections. Perfusion 2021; 37:722-728. [PMID: 34192996 DOI: 10.1177/02676591211028178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION A substantial amount of blood loss occurs during the open repair of aortic aneurysms or dissections. The aim of the present study is to determine the efficacy and cost-effectiveness of cell saver devices in blood conservation during the open repair of thoracic aortic pathologies. METHODS The present study prospectively collected the data pertaining to 25 patients who underwent surgical management of thoracic aortic aneurysms or dissections using a cell saver (Group 1, n = 25). The volume and cost of transfusion and postoperative outcomes were compared with the second group of patients who underwent surgery without the use of cell savers in the previous year (Group 2, n = 25); the data pertaining to the same were retrospectively collected from the hospital records. The patient characteristics and categorical variables were compared using the x2 test and Fisher's exact test. Transfusion volume and costs were compared using the independent samples t-test and Mann-Whitney U test. RESULTS The patients in both the groups displayed similar characteristics and risk factors. The total volume of allogenic red blood cell (p < 0.001) and total blood product (p = 0.01) transfusions were significantly lower in Group 1. The cost of red blood cell (p < 0.001) and total transfusions (p = 0.03) were lower in Group 1. The two groups displayed similar in-hospital morbidity and mortality rates. CONCLUSIONS There was a significant association between the use of cell savers and the decreased need for red blood cell and total blood product transfusions. Considering the cost of the cell saver set, transfusion costs in the two groups were comparable.
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Affiliation(s)
| | - Funda Yildirim
- Department of Cardiovascular Surgery, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Adnan Taner Kurdal
- Department of Cardiovascular Surgery, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Abdulkerim Damar
- Department of Cardiovascular Surgery, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Tulun Ozturk
- Department of Anesthesiology and Reanimation, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Omer Tetik
- Department of Cardiovascular Surgery, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
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17
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Abstract
A telephone survey of cardiac anaesthetists and perfusionists at the 29 public hospitals providing adult cardiac surgical services in Australia and New Zealand was carried out between December 2019 and January 2020. The aim was to investigate current practice with regard to selected contentious elements of anaesthetic and perfusion management during cardiopulmonary bypass; primarily relating to bypass circuit priming, blood conservation methods and point-of-care coagulation testing. There was a 100% response rate. The average number of adult public cardiopulmonary bypass cases per hospital was 508 (160-1400). For cardiopulmonary bypass cases, ten hospitals (34%) routinely used a cell saver and the remainder used a cell saver selectively. Residual blood remaining in the cardiopulmonary bypass circuit was processed using a cell saver routinely in four hospitals (14%) and selectively in 23 (79%). Acute normovolaemic haemodilution was rarely used. Retrograde autologous priming was used routinely in seven hospitals (24%) and selectively in 16 (55%). All hospitals had access to point-of-care coagulation testing. The majority of hospitals targeted an activated clotting time of 480 s (range 400-500 s) prior to commencing cardiopulmonary bypass. There was marked geographic variation in access to fibrinogen concentrate. The cardiopulmonary bypass circuit prime solution was primarily a balanced crystalloid in most hospitals; however, there was significant variation regarding the addition of human albumin, mannitol, sodium bicarbonate and other medications. Many of the interventions examined were used on a case-by-case basis. These findings support the need for further research to define more evidence-based practice of these interventions.
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Affiliation(s)
- Simon J Pattullo
- Department of Anaesthetics, Gold Coast Hospital and Health Service, Southport, Australia.,Griffith University, Brisbane, Australia.,Bond University, Robina, Australia
| | - David M Samson
- Department of Anaesthetics, Gold Coast Hospital and Health Service, Southport, Australia
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18
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Zhu NN, Lu MJ, Chen YQ, Jin XJ, Zhou X, Wei HW, Liu XQ, Duan LS, Yin L, Guo JR. Autologous blood transfusion stimulates wound healing in diabetic mice through activation of the HIF-1α pathway by improving the blood preservation solution. FASEB J 2020; 34:6038-6054. [PMID: 32202355 DOI: 10.1096/fj.201900324rrr] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 12/05/2019] [Accepted: 12/31/2019] [Indexed: 11/11/2022]
Abstract
Transfusion of autologous blood is a timesaving, convenient, safe, and effective therapy from a clinical perspective, and often employed for the treatment of diabetic patients. Stabilization of HIF-1α has been widely reported to be a critical factor in the improvement of wound healing in diabetes. Therefore, our study reveals the roles of improved autologous blood in wound healing in diabetes, through autologous blood transfusion in a mouse model. Initially, BALB/c mice were subjected to streptozotocin for diabetic mouse model establishment. Diabetic mice were transfused with improved or standard autologous blood in perfusion culture system. Roles of improved autologous blood in mediating HIF-1α pathway were determined by measuring expression of VEGF, EGF, HIF-1α, and HSP-90. In order to assess the detailed regulatory mechanism of improved autologous blood in perspective of wound healing, cell proliferation, migration and cell cycle, fibroblasts isolated from diabetic mice were transfected with HIF-1α siRNA. Mice transfused with improved autologous blood exhibited increased levels of CD31 and α-SMA in skin tissues, and reduced TNF-α, IL-1β, and IL-6 levels, indicating that improved autologous blood promoted wound healing ability and reduced the release of inflammatory factors. Diabetic mice transfused with improved autologous blood presented activated HIF-1α pathway. The survival rate, proliferation, and migration of fibroblasts were elevated via activation of the HIF-1α pathway. Taken together, improved blood preservation solution could enhance the oxygen carrying capacity of red blood cells and wound healing in mice with diabetes, which is achieved through regulation of HIF-1α pathway.
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Affiliation(s)
- Na-Na Zhu
- Department of Anesthesiology, Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Ming-Jun Lu
- Department of Anesthesiology, Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Yong-Quan Chen
- Department of Anesthesiology, Yijishan Hospital, the Wannan Medical College, Wuhu, P. R. China
| | - Xiao-Ju Jin
- Department of Anesthesiology, Yijishan Hospital, the Wannan Medical College, Wuhu, P. R. China
| | - Xun Zhou
- Department of Anesthesiology, Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China.,Ningxia Medical University, Gongli Hospital of Shanghai Pudong New Area Training Base, Shanghai, P. R. China
| | - Han-Wei Wei
- Department of Anesthesiology, Yijishan Hospital, the Wannan Medical College, Wuhu, P. R. China
| | - Xiao-Qian Liu
- Department of Anesthesiology, Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Li-Shuang Duan
- Department of Anesthesiology, Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Lei Yin
- Department of Anesthesiology, Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China
| | - Jian-Rong Guo
- Department of Anesthesiology, Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China.,Ningxia Medical University, Gongli Hospital of Shanghai Pudong New Area Training Base, Shanghai, P. R. China
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19
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Batista MFS, Costa CO, Vialle EN, Guasque JBRC, Fiorentin JZ, Souza CDS. Acute Normovolemic Hemodilution in Spinal Deformity Surgery. Rev Bras Ortop 2019; 54:516-523. [PMID: 31686710 PMCID: PMC6819157 DOI: 10.1016/j.rbo.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/21/2018] [Indexed: 11/25/2022] Open
Abstract
Objective
To prospectively compare the clinical and laboratorial aspects of patients undergoing spine deformity surgery, using the acute normovolemic hemodilution technique with tranexamic acid, versus a control group with tranexamic acid alone, and to evaluate the influence of hemodilution in intraoperative bleeding and the need for homologous transfusion.
Materials and Methods
Comparative prospective study with patients aged between 12 and 65 years undergoing spine deformity surgery with the acute normovolemic hemodilution technique associated with tranexamic acid versus a control group to which only tranexamic acid (15 mg/kg) was administered. Laboratorial exams were performed and analyzed in three different moments.
Results
A total of 30 patients were included in the present study: 17 in the hemodilution group, and 13 in the control group. The mean duration of the surgery in the hemodilution group was longer. The number of levels submitted to surgery ranged from 7 to 16 in the hemodilution group, and from 4 to 13 in the control group. Osteotomy, predominantly of the posterior kind, was performed in 20 patients. There was more intraoperative bleeding in the control group. All patients were stable during the procedures. Only 6 participants needed homologous blood transfusion, mostly from the control group (
p
> 0.05).
Conclusion
There was no significant difference between the two groups regarding the need for blood transfusion and intraoperative bleeding. The severity of the deformity was the main determinant for homologous blood transfusion.
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Affiliation(s)
- Marianna Fergutz Santos Batista
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
| | - Caroline Oliveira Costa
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
| | - Emiliano Neves Vialle
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
| | - Joana Bretas Rondon Cabral Guasque
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
| | - Joana Zulian Fiorentin
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
| | - Camila de Santiago Souza
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
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20
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Jia LH, Ma XM, Yan QL, Wu XS, Chen Y, Ye QH, Wang ZJ, Qiu MM, Zhu JH. Autologous Blood Transfusion and Pringle Maneuver in Laparoscopic Segmental Hepatectomy for Benign Hepatic Neoplasms: A Retrospective Study. J Laparoendosc Adv Surg Tech A 2019; 29:1571-1576. [PMID: 31682205 DOI: 10.1089/lap.2019.0407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives: To investigate the effect of autologous blood transfusion (ABT) and Pringle maneuver (PM) on postoperative early liver function and short-term postoperative results following laparoscopic liver resection in patients with benign hepatic neoplasms. Materials and Methods: We retrospectively analyzed the clinical data for 125 consecutive patients who underwent laparoscopic segmental hepatectomy from January 2015 to May 2018 (68 in the ABT group versus 57 in the PM group). We compared patients' characteristics and intra- and postoperative short-term outcomes between the groups. Results: The 2 groups were well matched regarding patients' clinical characteristics, types of liver resection, operative time, and histopathological findings (P > .05). Median blood loss was significantly lower in the PM group versus the ABT group (200 mL versus 750 mL, respectively; P < .01), and overall complication rates were similar (n = 12 [17%] versus n = 9 [16%], respectively; P > .05). The ABT group had significantly lower mean levels of total bilirubin, indirect bilirubin, aspartate transaminase, and alanine aminotransferase on postoperative days 1 and 3 (P < .05). The ABT group had a shorter hospital stay compared with the PM group (5.8 days versus 7.7 days, respectively; P < .05) and lower hospitalization costs (55,400 ± 15,400 versus 667,000 ± 21,600 CN dollars, respectively; P < .05). Conclusions: Compared with Pringle's maneuver, laparoscopic hepatectomy with ABT promoted early recovery of liver function and reduced hospitalization costs in select patients with benign hepatic neoplasms.
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Affiliation(s)
- Li-Hua Jia
- Department of General Surgery, Jinhua Hospital of TCM, Jinhua, China
| | - Xiao-Ming Ma
- Department of General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiu-Liang Yan
- Department of General Surgery, Jinhua People's Hospital, Jinhua, China
| | - Xiang-Song Wu
- Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing-Huang Ye
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Jiang Wang
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Man-Man Qiu
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin-Hui Zhu
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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21
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Roets M, Sturgess DJ, Wyssusek K, van Zundert AA. Intraoperative cell salvage: A technology built upon the failures, fads and fashions of blood transfusion. Anaesth Intensive Care 2019; 47:17-30. [PMID: 31674192 DOI: 10.1177/0310057x19860161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transfusion, as we know it today, developed into a very sophisticated treatment modality as a result of centuries of experimentation. Intraoperative cell salvage is a transfusion technique where autologous blood lost during surgery is reinfused. The success of this process relies on specialised equipment and techniques to collect, process, anticoagulate filter and reinfuse blood. Through a literature review, we collected information about the early origins of specific techniques relevant to intraoperative cell salvage: the ability to collect lost blood, to prevent collected blood from clotting, to remove debris through processing and other harmful aspects through filtering, the benefits of autologous blood transfusion, reinfusion and traditional concerns and contraindications. A culmination of knowledge specific to each of these techniques over centuries provides the background to the safe intraoperative cell salvage technique used today. In addition, we aimed to identify the reasons why specific equipment and techniques developed, why practice changed and what is still unknown. This article reviews relevant allogeneic transfusion and autotransfusion history, starting in Roman times, and includes landmark events through the centuries.
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Affiliation(s)
- Michelle Roets
- University of Queensland, Brisbane, Australia.,Anaesthetic Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - David J Sturgess
- University of Queensland, Brisbane, Australia.,Anaesthetic Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Kerstin Wyssusek
- University of Queensland, Brisbane, Australia.,Anaesthetic Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - André A van Zundert
- University of Queensland, Brisbane, Australia.,Anaesthetic Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
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22
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Matsuzawa R, Murata H, Sato M, Miyazaki R, Tanaka T, Shimizu N, Tateishi K, Suenaga J, Yamamoto T. Autologous Transfusion of Blood Aspirated during Suction Decompression in Clipping of Large or Giant Cerebral Aneurysm. Neurol Med Chir (Tokyo) 2019; 59:351-356. [PMID: 31231087 PMCID: PMC6753252 DOI: 10.2176/nmc.tn.2018-0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The suction decompression (SD) method, which proactively aspirates the blood flowing into the aneurysm and reduces the internal pressure of the aneurysm, is useful for clipping surgery of large and giant cerebral aneurysm. However, there has been little discussion on re-utilization of blood aspirated during SD. This study aimed to examine the safety, convenience, and usefulness of autologous transfusion of aspirated blood using a transfusion bag. At the time of craniotomy, the cervical carotid artery is fully exposed. An angiocatheter sheath was inserted into the carotid artery and placed in the internal carotid artery. In SD, blood was aspirated from the sheath at a constant speed and quickly stored in a blood transfusion storage bag. Blood aspiration was repeated with a new syringe; once the transfusion bag was full, the blood was re-administered to the patient. Changes in vital sign and hemoglobin/hematocrit values before and after SD were examined in five cases performed in this procedure. The aspirated blood volumes of five cases ranged from 130 to 400 mL, and all aspirated blood was successfully re-transfused. There was no critical change in vital sign, and no significant decrease in the hemoglobin/hematocrit value. No findings suggestive of complications of thrombus formation, infection, and hemolysis were noted. Re-transfusion of aspirated blood during SD using a transfusion bag is a simple and safe method, which can minimize potential risk of re-utilizing aspirated blood, and enables the safe and easy execution of SD regardless of aspirated blood volume.
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Affiliation(s)
- Ryo Matsuzawa
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Hidetoshi Murata
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Mitsuru Sato
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Ryohei Miyazaki
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Takahiro Tanaka
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Nobuyuki Shimizu
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Kensuke Tateishi
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Jun Suenaga
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
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23
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Cho Y, Woo JH, Kwon OS, Yoon SS, Son J. Alterations in phospholipid profiles of erythrocytes deep-frozen without cryoprotectants. Drug Test Anal 2019; 11:1231-1237. [PMID: 30950199 DOI: 10.1002/dta.2600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 11/09/2022]
Abstract
The erythrocyte membrane is composed of a phospholipid bilayer, which is known to undergo physicochemical changes during storage at low temperatures. This study was conducted to identify marker phospholipids that indicate alteration during deep-frozen storage and to determine the amount of marker phospholipids. Our research suggested a method to detect phospholipids by profiling analysis of thermally injured red blood cells (RBCs) without protecting agents. Human blood was stored at -80°C for 72 days. The RBC membrane phospholipids were extracted through a modified Bligh and Dyer method. Six selected phospholipids were analyzed and quantified using liquid chromatography-tandem mass spectrometry, and an in vitro model system was developed. The intracellular level of N-nervonoyl-D-erythro-sphingosylphosphorylcholine significantly increased in the thermally injured RBCs, and multiple biomarker candidates were evaluated by profiling analysis and mass spectrometry technology for targeted metabolomics.
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Affiliation(s)
- Yoeseph Cho
- Doping Control Center, Korea Institute of Science and Technology, Seongbuk-gu, Seoul, Republic of Korea.,Department of Microbiology and Immunology, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Ji-Hye Woo
- Doping Control Center, Korea Institute of Science and Technology, Seongbuk-gu, Seoul, Republic of Korea
| | - Oh-Seung Kwon
- Doping Control Center, Korea Institute of Science and Technology, Seongbuk-gu, Seoul, Republic of Korea.,Department of Biological Chemistry, Korea University of Science and Technology (UST), Daejeon, Republic of Korea
| | - Sang Sun Yoon
- Department of Microbiology and Immunology, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Junghyun Son
- Doping Control Center, Korea Institute of Science and Technology, Seongbuk-gu, Seoul, Republic of Korea.,Department of Biological Chemistry, Korea University of Science and Technology (UST), Daejeon, Republic of Korea
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24
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Moua PK, Nguyen CL, Piotrowski DA, Resch MJ, Tabassum T, Noonan K, Nimunkar AJ. Surgical sponge blood salvage spinning device design and testing. J Med Eng Technol 2019; 42:426-434. [PMID: 30657356 DOI: 10.1080/03091902.2018.1543465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
One method to clear intraoperative blood from the surgical field is to remove blood with surgical sponges. Currently, absorbed blood cannot be retrieved effectively and is lost. A spinning device was created to salvage red blood cells from the sponges. With this device the sponges are gently washed with saline and the resultant bloody fluid can be delivered to a cell saver to prepare it for autologous blood transfusion. In this article, we demonstrate how a novel sponge extractor can be used to extract blood from sponges. Several tests were conducted with porcine blood to optimise viable blood salvage by varying spin speed, and spin time of the device. At spin speeds greater than 1000 RPM, the blood salvaged from the device was similar to blood volumes obtained by hand wringing sponges. Cell viability testing yielded no significant differences in haemolysis for device trials compared to gently hand wringing. Spin time testing showed no significant differences in the blood salvaged at times greater than one minute. Optimal parameters for the device were determined to be a one-minute spin time at 1500 RPM.
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Affiliation(s)
- Peter K Moua
- a Department of Biomedical Engineering , University of Wisconsin-Madison , Madison , WI , USA
| | - Christopher L Nguyen
- a Department of Biomedical Engineering , University of Wisconsin-Madison , Madison , WI , USA
| | - David A Piotrowski
- a Department of Biomedical Engineering , University of Wisconsin-Madison , Madison , WI , USA
| | - Mitchell J Resch
- a Department of Biomedical Engineering , University of Wisconsin-Madison , Madison , WI , USA
| | - Tasnia Tabassum
- a Department of Biomedical Engineering , University of Wisconsin-Madison , Madison , WI , USA
| | - Kenneth Noonan
- b Department of Orthopedics and Rehabilitation, School of Medicine and Public Health , University of Wisconsin-Madison , Madison , WI , USA
| | - Amit J Nimunkar
- a Department of Biomedical Engineering , University of Wisconsin-Madison , Madison , WI , USA
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25
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Kaiser A, Miller K, Tian G, Moore RH, Guzzetta NA. Feasibility of autologous intraoperative blood collection and retransfusion in small children with complex congenital heart defects undergoing cardiopulmonary bypass. Paediatr Anaesth 2018; 28:795-802. [PMID: 30079485 DOI: 10.1111/pan.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Allogeneic blood product transfusion is common in pediatric patients undergoing cardiopulmonary bypass although it is associated with an increased risk for adverse events. Furthermore, numerous donor exposures may affect future blood transfusion needs and human leukocyte antigen matching for patients who may ultimately require cardiac transplantation. Autologous intraoperative blood collection and retransfusion is a known method of blood preservation, but has not been extensively practiced in pediatric patients. In this study we assess the feasibility of this blood conservation technique in small children with complex congenital heart defects undergoing cardiopulmonary bypass. METHODS After Institutional Review Board approval, we retrospectively reviewed the medical records of children weighing <10 kg who underwent cardiopulmonary bypass over a 2-year period. Eighteen patients underwent autologous intraoperative blood collection and retransfusion and comprised the study group. Eighteen control patients were chosen by a 1:1 matched design using preoperative hematocrit, surgical procedure, and body weight. Multiple corresponding demographic and surgical variables, transfusion data, and clinical outcomes were compared. RESULTS Patient demographics, operative parameters and preoperative laboratory, and coagulation values were similar between the two groups. Despite the removal of autologous blood, study patients did not require more inotropic support prior to cardiopulmonary bypass. They also did not experience a significant increase in bleeding as measured by 24-hour postoperative chest tube output. Study patients were exposed to significantly fewer donor units intraoperatively and within the first 24 hours postoperatively. DISCUSSION The use of autologous intraoperative blood collection and retransfusion is a feasible option for small children with complex congenital heart defects undergoing cardiopulmonary bypass. Study patients received significantly fewer donor exposures without an increase in postoperative bleeding. Children who require multiple cardiac surgeries or eventually transplantation could benefit from this blood conservation technique.
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Affiliation(s)
- Ania Kaiser
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kati Miller
- Department of Clinical Research, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ganzhong Tian
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nina A Guzzetta
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Atlanta, Georgia
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26
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Sawamura Y, Ohto H, Ikeda K, Kanno T, Suzuki Y, Gonda K, Tasaki T, Nollet KE, Takahashi H, Aota S. Impact of prestorage leucoreduction of autologous whole blood on length of hospital stay with a subgroup analysis in bilateral hip arthroplasty. Vox Sang 2018; 113:584-593. [PMID: 29923207 DOI: 10.1111/vox.12674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although prestorage leucoreduction (LR) of blood components for transfusion has gained favour around the world, evidence of its beneficial clinical effects is ambiguous. STUDY DESIGN AND METHODS To reveal whether leucocytes and/or platelets in transfused blood are related to transfusion-related adverse effects, a prospective randomized crossover study was performed on patients who donated autologous blood prior to elective surgery. Among 1487 primary enrolees, a total of 192 patients undergoing two-stage, bilateral total hip arthroplasty were randomized to receive autologous blood that was either prestorage leucoreduced, or not, for the first procedure. For the second procedure, each patient was crossed over to receive alternatively processed autologous blood. Length of hospital stay served as a primary end-point, with perioperative infectious/thrombotic complications, pre- and postoperative laboratory values, and body temperature serving as secondary endpoints. RESULTS No significant differences emerged between prestorage LR and non-LR cohorts in length of hospital stay, as well as perioperative infectious/thrombotic complications, postoperative body temperature and duration of fever. Postoperative laboratory values including white blood cell counts and C-reactive protein levels had no significant differences. CONCLUSION This study could not prove any superiority of prestorage LR over non-LR for autologous whole blood among patients who underwent total hip arthroplasty.
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Affiliation(s)
- Y Sawamura
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan
- Japanese Red Cross Miyagi Blood Center, Sendai, Japan
| | - H Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan
| | - K Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan
| | - T Kanno
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan
- Japanese Red Cross Fukushima Blood Center, Fukushima, Japan
| | - Y Suzuki
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan
| | - K Gonda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan
| | - T Tasaki
- Department of Blood transfusion, Jikei University Hospital, Tokyo, Japan
| | - K E Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan
| | - H Takahashi
- National Institute of Public Health, Saitama, Japan
| | - S Aota
- Department of Orthopedic Surgery, Fukushima Medical University Hospital, Fukushima, Japan
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27
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Zeng K, Huang W, Yu C, Wang R. How about "The effect of intraoperative cell salvage on allogeneic blood transfusion for patients with placenta accreta"?: An observational study. Medicine (Baltimore) 2018; 97:e10942. [PMID: 29851834 PMCID: PMC6392750 DOI: 10.1097/md.0000000000010942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Intraoperative cell salvage (IOCS) for high-risk obstetric hemorrhage is now endorsed by a number of obstetric organizations. Most previous studies have focused on the safety of IOCS from case series and small controlled studies. Here, we describe the effect of IOCS on rates of allogeneic blood transfusion (ABT) under different degrees of bleeding during cesarean section in women with placenta accreta, which has seldom been reported in the literature.We conducted a retrospective analysis on the introduction of routine application of IOCS for the management of hemorrhage during cesarean section in women with placenta accreta. We identified 115 women, with prenatally diagnosed placenta accreta/increta/percreta before this change in practice, who served as controls, and 108 women who had IOCS applied during cesarean section.Compared with the control treatment, IOCS was significantly associated with a lower incidence of ABT (odds ratio, 0.179; 95% confidence interval, 0.098-0.328). Among the women with ≤3000 mL of bleeding, ABT was avoided in 80 (93.0%) of the 86 patients in the IOCS group, while 49 (50.0%) of the 98 controls required ABT. For women with an estimated blood loss >3000 mL, the reinfused IOCS blood may have helped prevent the need for ABT in 6 (28.6%) of the 21 patients, while all of the 17 controls required ABT. Subgroup analysis of coagulation function and the need for coagulation components showed no significant difference between the 2 groups (P > .05). Compared with the control treatment, IOCS was associated with a lower intraoperative volume of crystalloid (P < .01) and colloid infusion (P < .01) and a shorter length of postoperative hospital stay (P < .01) in patients with placenta accreta. In addition, there were no complications or adverse reactions in patients with placenta accreta who underwent IOCS.IOCS helped reduce the need for ABT and fluid transfusion in patients with placenta accreta and may be safe for use in obstetrics.
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Affiliation(s)
- Kui Zeng
- Department of Anaesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan
| | - Wei Huang
- Department of Anaesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan
| | - Chao Yu
- Department of Anaesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan
| | - Rurong Wang
- Department of Anaesthesiology, West China Hospital of Sichuan University, Sichuan University, Chengdu, China
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28
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Liu X, Fan R, Lu Y, Kuang L, Yuan Q, Chen Y, Lin Z, Lin D. Influence of autologous blood transfusion in liver transplantation in patients with hepatitis B on the function and hemorheology of red blood cells. Exp Ther Med 2017; 14:1205-1211. [PMID: 28781620 PMCID: PMC5526186 DOI: 10.3892/etm.2017.4587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 03/24/2017] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to characterize the function and hemorheology of red blood cells (RBCs) recovered during liver transplantation surgery in patients with hepatitis B and decompensation. A total of 15 hepatitis B patients with decompensation who underwent liver transplantation surgery were included in the present study. Blood samples were recovered during the liver transplantation surgery using an Autologous Blood Recovery System. The morphology and structure of RBCs were characterized and compared between pre-operative and recovered blood samples. In addition, the physiological functions of RBCs were measured and compared between pre-operative and recovered blood samples. No significant differences in the morphological score, 2,3-diphosphoglycerate, Na+K+-ATPase, Ca2+-ATPase, Mg2+-ATPase, malondialdehyde and osmotic fragility were identified between RBCs in the pre-operative and recovered blood samples. The level of free hemoglobin in RBCs of the recovered blood samples was significantly higher than in the pre-operative blood samples (P<0.05). Medium- and high-shear blood viscosities in the recovered blood samples were significantly lower than those observed in the pre-operative blood samples (P<0.05). Casson viscosity in the recovered blood samples was significantly higher compared with the pre-operative blood samples. However, no significant differences (P>0.05) in the low-shear blood viscosity, plasma viscosity, relative blood viscosity, erythrocyte aggregation index or Casson yield stress were identified between recovered and pre-operative blood samples. These findings suggested that autologous blood transfusion in liver transplantation surgery in patients with hepatitis B and decompensation had no significant influence on the morphology, structure, function and hemorheology of RBCs.
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Affiliation(s)
- Xiangfu Liu
- Department of Blood Transfusion, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Ruifang Fan
- Department of Hematology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Ying Lu
- Department of Blood Transfusion, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Lihua Kuang
- Department of Blood Transfusion, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Qing Yuan
- Department of Blood Transfusion, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Yuchan Chen
- Department of Blood Transfusion, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Zhesheng Lin
- Department of Blood Transfusion, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Dongjun Lin
- Department of Hematology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China
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29
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Oliveira JAA, Façanha Filho FAM, Fernandes FV, Almeida PC, de Oliveira VF, Lima Verde SR. Is cell salvage cost-effective in posterior arthrodesis for adolescent idiopathic scoliosis in the public health system? J Spine Surg 2017; 3:2-8. [PMID: 28435911 DOI: 10.21037/jss.2017.02.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To evaluate the efficacy and cost-effectiveness of cell salvage (CS) in reducing allogeneic transfusion in patients undergoing surgery for idiopathic scoliosis. METHODS A case-control study with 42 patients with adolescent idiopathic scoliosis (AIS), submitted to posterior arthrodesis with instrumentation from 8/2008 to 12/2014 at the General Hospital of Fortaleza, Brazil. CS was used in 27 patients and not used in 15. The data was processed using the SPSS 20.0. The confidence level was 0.05. RESULTS There were no significant differences between the groups for the variables of age, sex, preoperative weight, postoperative blood drainage, and surgical time. There was a significant reduction in the intra-operative allogeneic transfusion in the case group compared to the control; there was no significant difference in the postoperative period. Adding the two periods together there was a significant difference with less allogeneic red blood cells (RBC) transfused in the CS group. The total cost of allogeneic RBC between the intra and postoperative groups was higher in the control group (P=0.01). Due to this difference ($350.00-$136.93) the cost was $213.07. The net savings were $213.07. Multiplying this by the 27 subjects, allogeneic RBC transfusion led to a cost reduction of $5,752.89 for the State. CONCLUSIONS The CS was effective in reducing allogeneic transfusion during surgery and in the total period that AIS patients underwent surgery it was also cost-effective.
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Affiliation(s)
- José A A Oliveira
- Orthopedics and Traumatology Service, Albert Sabin Children's Hospital/General Hospital of Fortaleza, Fortaleza, Ceará, Brazil
| | | | | | | | - Vládia F de Oliveira
- Orthopedics and Traumatology Service, Dr. José Frota Hospital Institute, Fortaleza, Ceará, Brazil
| | - Saulo R Lima Verde
- Spinal Surgery Group, General Hospital of Fortaleza, Fortaleza, Ceará, Brazil
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30
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Sebastian R, Ratliff T, Winch PD, Tumin D, Gomez D, Tobias J, Galantowicz M, Naguib AN. Revisiting acute normovolemic hemodilution and blood transfusion during pediatric cardiac surgery: a prospective observational study. Paediatr Anaesth 2017; 27:85-90. [PMID: 27734554 DOI: 10.1111/pan.13014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The majority of allogeneic transfusions occur in the perioperative setting, especially during cardiac surgery. In addition to the economic implications, there is emerging evidence that blood transfusion may increase both morbidity and mortality. Acute normovolemic hemodilution (ANH) may limit the need for blood products. OBJECTIVES The primary objective of this study was to determine if the method of blood collection (syringe or bag) during the ANH process impacted the platelet count and function. The secondary objectives included the need for perioperative blood transfusions during the procedure and in the intensive care unit. In addition, we assessed these outcomes' associations with ANH parameters including the method of collection, time of storage, and volume removed. METHODS Data were collected prospectively from 50 patients undergoing cardiac surgery on cardiopulmonary bypass over a 6-month period. Platelet count and function were measured for the ANH blood immediately after collection and again prior to transfusing to the patient at the end of cardiopulmonary bypass. Other data collected included ANH volume, length of storage, and the quantity of all blood products given throughout the perioperative period. RESULTS No change in platelet count or function was noted regardless of the length of time or collection method for the ANH blood. Twenty-three patients received blood or blood products in the operating room or the intensive care unit, while 27 patients received no blood transfusion during their entire hospitalization. Higher ANH volume (ml·kg-1 ) and longer storage time were associated with a greater need for intraoperative transfusions. CONCLUSION Acute normovolemic hemodilution protects the platelets from the untoward effects of cardiopulmonary bypass and offers an important autologous blood product that improves hemostasis at the conclusion of surgery. Platelet count and function are preserved regardless of the method of collection or the length of storage. The volume of ANH removed appears to be an important determinant of blood product use and further understanding of the impact of this variable is a future direction of upcoming prospective research.
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Affiliation(s)
- Roby Sebastian
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Todd Ratliff
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter D Winch
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel Gomez
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Tobias
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Galantowicz
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Aymen N Naguib
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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Ma HS, Ma JH, Xue FL, Fu XN, Zhang N. Clinical analysis of thoracoscopic surgery combined with intraoperative autologous blood transfusion in the treatment of traumatic hemothorax. Chin J Traumatol 2016; 19:371-372. [PMID: 28088945 PMCID: PMC5198928 DOI: 10.1016/j.cjtee.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
From January 2013 to January 2015, 19 patients of traumatic hemothorax with hemorrhagic shock were treated in our department by thoracoscopic surgery combined with autologous blood transfusion. This study retrospectively analyzed the therapeutic effect and shared our experience. The average amount of blood transfused back was 662.41 ml ± 269.15 ml. None of the patients developed transfusion reaction and were all discharged uneventfully. Thoracoscopic surgery combined with autologous blood trans- fusion is effective in the rescue of patients with progressive hemothorax and hemorrhagic shock. When corresponding indications are well managed, treatment for these patients is quicker, safer, and more effective.
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Affiliation(s)
- Hu-Sai Ma
- Department of Thoracic Surgery, Qinghai Provincial People's Hospital, Xining 810007, Qinghai Province, China
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ju-Hua Ma
- Department of Thoracic Surgery, Qinghai Provincial People's Hospital, Xining 810007, Qinghai Province, China
| | - Feng-Lai Xue
- Department of Thoracic Surgery, Qinghai Provincial People's Hospital, Xining 810007, Qinghai Province, China
| | - Xiang-Ning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Corresponding author.
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Abstract
PURPOSE There are multiple reported risk factors and a wide range of reported blood transfusion rates for total shoulder arthroplasty (TSA). There are no evidence-based guidelines for blood transfusions in TSA patients. MATERIALS AND METHODS We utilized the Nationwide Inpatient Sample to analyze 51,191 patients undergoing TSA between 1998 and 2011. The purpose was to describe the incidence and identify the preoperative factors that are independently associated with blood transfusion after TSA. In addition, we studied the association of blood transfusions with certain variables such as length of stay (LOS), total charges, and payer status. RESULTS The blood transfusion rate in our study was 6.1%. There was no difference in the rate of blood transfusions over the study period (P < 0.001). In our logistic regression model, significant associations were found with increased age (odds ratio [OR] =1.03), white race (OR = 1.05), higher Charlson-Deyo score (OR = 1.12), presence of ischemic heart disease (OR = 1.24), blood loss anemia (OR = 1.65), female gender (OR = 1.94), presence of coagulation disorders (OR = 2.25), and presence of deficiency anemia (OR = 3.5). Patients receiving a blood transfusion had higher total charges, a longer hospital LOS, and were more likely to be Medicare payers (P < 0.001). CONCLUSIONS Our study found five clinically significant risk factors for blood transfusions for TSA: female gender, ischemic heart disease, deficiency anemia, coagulation disorder, and blood loss anemia. Patients with these risk factors should be considered higher risk for requiring a blood transfusion after TSA and counseled appropriately. LEVEL OF EVIDENCE Level II, retrospective cohort study, prognostic study.
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Affiliation(s)
- Abdurrahman Kandil
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Justin W Griffin
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA
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Minatoguchi M, Itakura A, Miki A, Kajihara T, Sasaki S, Takase Y, Kobayashi K, Asada R, Ikebuchi K, Ishihara O. Coagulation factors in whole blood collected from pregnant women and stored at 4°C. Nagoya J Med Sci 2016; 78:1-7. [PMID: 27019523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study aimed to measure the levels of coagulation factors in stored whole blood of pregnant women and to determine their usefulness in treating pregnant women who developed coagulopathy. A prospective study to measure coagulation factors in stored donated whole blood from pregnant and non-pregnant women was conducted. Fibrinogen, FV, FVII, FVIII, FXIII, and von Willebrand factor were measured in blood stored at 4°C for 0, 1, 3, and 5 weeks. All coagulation factors except for factor XIII decreased during storage. Fibrinogen and factor VII in the blood collected from pregnant women gradually decreased over time and their levels were significantly higher after 5 weeks of storage than those of non-pregnant women at week 0. Whole blood donated by pregnant women for autologous blood transfusion and stored at 4°C may be expected being effectively for the prevention of coagulopathy and the treatment of circulatory blood volume loss.
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Oh AY, Seo KS, Lee GE, Kim HJ. Effect of preoperative autologous blood donation on patients undergoing bimaxillary orthognathic surgery: a retrospective analysis. Int J Oral Maxillofac Surg 2015; 45:486-9. [PMID: 26678802 DOI: 10.1016/j.ijom.2015.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/22/2015] [Accepted: 11/13/2015] [Indexed: 11/29/2022]
Abstract
The efficacy of preoperative autologous blood donation (PABD) was evaluated according to preoperative haemoglobin (Hb) values. The records of 295 patients who underwent bimaxillary orthognathic surgery between July 2007 and August 2008 were reviewed. The records for autologous blood donation, intraoperative transfusion, and related laboratory studies were also evaluated. The transfusion trigger used during this period was Hb < 10 g/dl. A total of 189 patients (64.1%) made a PABD and 106 patients (35.9%) did not. The incidence of allogeneic blood transfusion was significantly lower in the PABD group than in the no PABD group (15.9% vs. 29.2%, P = 0.007). This difference was greater in patients with a preoperative Hb < 14 g/dl (20.3% vs. 62.5%, P < 0.0001), and no difference was found in patients with Hb ≥ 14 g/dl (13.3% vs. 14.9%, P = 0.83). PABD reduced the incidence of allogeneic blood transfusion in patients undergoing bimaxillary orthognathic surgery, particularly in patients with a preoperative Hb < 14 g/dl. PABD could be used to reduce the frequency of intraoperative allogeneic blood transfusion in these patients.
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Affiliation(s)
- A Y Oh
- Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - K S Seo
- Department of Dental Anaesthesiology, Seoul National University School of Dentistry, Seoul, South Korea.
| | - G E Lee
- Department of Dental Anaesthesiology, Seoul National University School of Dentistry, Seoul, South Korea
| | - H J Kim
- Department of Dental Anaesthesiology, Seoul National University School of Dentistry, Seoul, South Korea
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Tamai K, Terai H, Toyoda H, Suzuki A, Yasuda H, Dozono S, Nakamura H. Which is the best schedule of autologous blood storage for preoperative adolescent idiopathic scoliosis patients? Scoliosis 2015; 10:S11. [PMID: 25815051 PMCID: PMC4331728 DOI: 10.1186/1748-7161-10-s2-s11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background It is critically important for AIS patients to avoid perioperative allogeneic blood transfusions. Toward this aim, many institutes use autologous blood storage to perform perioperative transfusions. However, there is no standard timeline for collecting blood for storage. Therefore, the objective of this prospective cohort study was to compare the outcome of two different schedules for collecting autologous blood before operation in adolescent idiopathic scoliosis (AIS) patients. Methods Inclusion criteria are AIS patients, younger than 20 years old, female, operated between 2009 and 2013 with posterior spinal fusion and instrumentation who had 1600 mL autologous blood collected before operation. A total of 61 patients were participated in this study. They were randomly divided into 2 groups based on the storage interval. Weekly group (1W-G) consisted of 30 patients with a total of 1600mL blood collected weekly beginning 4 weeks before the operation. Biweekly group (2W-G) consisted of 31 patients with a total of 1600 mL blood collected biweekly beginning 8 weeks before the operation. The instrumented levels, total bleeding, complications during blood transfusion, and hematological examinations (RBC, Hb, Hct, MCH, MCV, MCHC) were evaluated. A hematological examination was performed before blood collection, before the operation, and on postoperative days 1, 3, and 7. Vasovagal reflex (VVR) was evaluated as complications during blood drawing. Result Mean age, height, and weight did not differ significantly between the 2 groups. There were no significant differences in instrumented levels, bleeding during operation, after operation, and collected blood during operation. With the autologous blood, allogeneic blood transfusion was completely avoided. VVR was more frequent in the biweekly group significantly (1W-G 4.2% vs 2W-G 15.3%). In terms of hematological examination, all values showed no significant differences between two groups in the pre-drawing and the pre-operation stage. However, the postoperative Hb and Hct values were higher in the weekly group. Also, MCV and MCHC showed the same behavior with higher values in the weekly group. Conclusion A weekly schedule of autologous blood storage is better than a biweekly storage schedule.
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Affiliation(s)
- Koji Tamai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Yasuda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shou Dozono
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Abstract
BACKGROUND The steady rise in demand for total hip arthroplasty constitutes a significant and increasing burden on health care resources. The biggest contributors to the total cost of hip replacement procedures other than the price of the implant are hospital stay and postoperative rehabilitation. Blood management is one of the most adjustable factors that can impact length of stay and cost-efficiency while improving patient safety. QUESTIONS/PURPOSES The primary purpose of this retrospective study was to assess the potential impact of blood management interventions on length of hospital stay after primary unilateral total hip arthroplasty. This was achieved by first identifying which patient and surgical factors are associated with an increased risk of prolonged hospital stay. Subsequently, the significant factors were controlled for through a multivariate regression analysis to quantify the association between blood transfusions and increased hospital stay. METHODS Retrospectively, the study included 2,104 primary total hip replacements. Eight hundred eighty-eight procedures were performed on males and 1,216 on females, with a mean age of 64 years at the time of the surgery (range 18-94 years) and BMI of 28.6 kg/m(2) (range 12-51.5 kg/m(2)). The correlation between each factor and length of stay was analyzed separately using univariate regression analysis. Those variables with p ≤ 0.05 in the univariate model were selected for inclusion in the multivariate logistic regressions. Multiple linear regression was used to analyze the effect of each significant factor and derive odds ratios with adjustment for the other variables. RESULTS Multivariate Poisson regression revealed that increased length of stay was significantly correlated to patient age (p = 0.05), the use of coumadin (p = 0.02) or lovenox/heparin (p = 0.007) as opposed to aspirin for anticoagulation, and allogeneic blood transfusion (p < 0.0001). The data shows that allogeneic blood transfusion is associated with a longer hospital stay regardless of absolute drop in hemoglobin level postoperatively or at discharge or the number of units transfused (OR = 1.18, 95% CI = 1.09 to 1.28, p < 0.001). CONCLUSION Transfusion of allogeneic blood is independently associated with increased hospital stay after total hip arthroplasty. Blood management modalities that can significantly reduce transfusion risk could impact length of stay as well as the total cost of hip replacement procedures.
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Horstmann W, Kuipers B, Ohanis D, Slappendel R, Kollen B, Verheyen C. Autologous re-transfusion drain compared with no drain in total knee arthroplasty: a randomised controlled trial. Blood Transfus 2014; 12 Suppl 1:s176-s181. [PMID: 24120589 PMCID: PMC3934246 DOI: 10.2450/2013.0072-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Post-operative anaemia following total knee arthroplasty is reported to impede functional mobility in the early period following surgery, whereas allogeneic blood transfusions, used to correct low post-operative haemoglobin levels, have concomitant disadvantages. The use of a post-operative autologous blood re-transfusion drainage system as well as no drainage system following total knee arthroplasty have been shown to reduce peri-operative blood loss and allogeneic blood transfusions, compared to the regularly used closed-suction drains. No randomised studies have been performed, to the best of our knowledge, that indicate the superiority of either method. MATERIALS AND METHODS An open, randomised controlled study was conducted in 115 patients undergoing total knee arthroplasty who were randomly allocated to an autotransfusion drain or no drainage system. The primary end-point was haemoglobin level on the first post-operative day. RESULTS In the autotransfusion group 515 mL (0-1,500 mL) of drained blood was re-transfused within the first 6 hours after surgery. Haemoglobin levels on the first (11.6 vs 11.0 g/dL), second (11.0 vs 10.3 g/dL) and third (10.5 vs 9.8 g/dL) days after surgery were significantly higher in the autotransfusion group. Total peri-operative net blood loss (1,576 mL vs 1,837 mL; -P=0.03) and allogeneic transfusion rates (10.2% vs 19.6%; P=0.15) were lower in the autotransfusion group. There were no differences in pain scores, range of motion or adverse events during hospital stay and the first 3 months after surgery. DISCUSSION Compared with no drainage, the use of a post-operative autologous blood re-transfusion drainage system following total knee arthroplasty results in higher post-operative haemoglobin levels and less total blood loss.
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Affiliation(s)
| | | | | | - Robert Slappendel
- Department of Quality and Safety, Amphia Hospital, Breda, The Netherlands
| | - Boudewijn Kollen
- Department of General Practice, University Medical Center Groningen, University of Groningen, The Netherlands
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Tomimaru Y, Eguchi H, Wada H, Hama N, Kawamoto K, Kobayashi S, Umeshita K, Doki Y, Mori M, Nagano H. Predicting the necessity of autologous blood collection and storage before surgery for hepatocellular carcinoma. J Surg Oncol 2013. [PMID: 24009154 DOI: 10.1038/nphoton.2013.80] [Citation(s) in RCA: 909] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND AND OBJECTIVES It remains unclear what kinds of patients undergoing hepatectomy for hepatocellular carcinoma (HCC) actually need autologous blood storage/transfusion. METHODS Prior to surgery, autologous blood storage was prospectively performed in 245 patients with HCC, whereas it was not performed in 40 patients. Based on the use of the deposited autologous blood and the estimated postoperative hemoglobin (Hb) level when blood was not deposited, they were divided into necessary group and unnecessary group. By comparing the two groups, a scoring system to predict the need for autologous blood was established. RESULTS The 245 patients from whom blood was collected and stored were categorized into necessary group (32 patients with homologous blood transfusion and 11 with estimated postoperative Hb of <8.0 g/dl) and unnecessary group (30 patients with autologous blood discarded and 172 with estimated Hb ≥ 8.0 g/dl). Using factors that were significantly different between the two groups, a scoring system to predict the need for autologous blood was developed; preoperative Hb level, tumor size, and tumor thrombus. The area under the receiver-operator characteristic curve of the score was 0.836. CONCLUSIONS The established scoring system was found useful in identifying those HCC patients who need autologous blood storage/transfusion during hepatectomy.
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Affiliation(s)
- Yoshito Tomimaru
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Singh VK, Singh PK, Javed S, Kumar K, Tomar J. Autologous transfusion of drain contents in elective primary knee arthroplasty: its value and relevance. Blood Transfus 2011; 9:281-285. [PMID: 21084012 PMCID: PMC3136595 DOI: 10.2450/2010.0155-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 07/08/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Total knee arthroplasty is associated with significant post-operative blood loss often necessitating blood transfusions. Blood transfusions may be associated with transfusion reactions and may transmit human immunodeficiency virus, hepatitis C virus and hepatitis B virus, with devastating consequences. After total knee arthroplasty, transfusion of the contents of an autologous drain is becoming common practice. The aim of our study was to look at the effectiveness of these drains in elective primary total knee arthroplasty. MATERIALS AND METHODS A prospective study was conducted including 70 non-randomised patients. A normal suction drain was used in 35 patients (group A), whereas in the other 35 patients, a CellTrans™ drain was used (group B). All the operations were performed by four surgeons using a tourniquet with a medial parapatellar approach. Pre- and post-operative haemoglobin concentrations were recorded in both groups. A Student's t-test was applied to determine the statistical significance of the data collected. RESULTS The average fall in post-operative haemoglobin was 3.66 g/dL (SD 1.46; range, 0.6-7.0) among patients in whom the simple drain was used (group A) and 2.29 g/dL (SD 0.92; range, 0.6-5.9) among those in whom the CellTrans™ drain was used (group B) (p<0.0001). Twenty-five units of allogeneic blood were required in group A compared to four units in group B. The rate of transfusion was 5.7% (2 patients) in the group in which CellTrans™ drain was used and 25.7% (9 patients) in the group in which a simple suction drain was used. DISCUSSION Total knee arthroplasty is associated with significant post-operative blood loss despite best operative technique. Autologous reinfusion of the contents of a CellTrans™ drain significantly reduces the rate of post-operative blood transfusion. This study indicates that the use of an autologous drain could be recommended as routine practice in primary total knee arthroplasty.
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Affiliation(s)
- Vinay Kumar Singh
- Trauma & Orthopaedics and Spinal Surgery, Luton and Dunstable Hospital NHS Foundation Trust, Luton, United Kingdom.
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Mason L, Fitzgerald C, Powell-Tuck J, Rice R. Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation. Ann R Coll Surg Engl 2011; 93:398-400. [PMID: 21943465 PMCID: PMC3365460 DOI: 10.1308/003588411x579801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A number of ways of reducing blood loss in arthroplasty have been explored, including preoperative autologous transfusion, intraoperative cell salvage and postoperative autologous transfusions. Both intraoperative blood salvage and postoperative retransfusion drains have been shown to be effective in reducing blood loss in total hip arthroplasty. In our department there was a change in practice from using postoperative retransfusion drains to intraoperative cell salvage. To our knowledge no study has directly compared using intraoperative blood salvage and postoperative retransfusion drains alone in total hip arthroplasty. METHODS This was a retrospective service evaluation including all primary hip arthroplasty performed under our care between January 2006 and December 2008. Patients were divided into two groups: Group A used a postoperative autologous blood transfusion (ABT) drain and Group B used intraoperative cell salvage. RESULTS A total of 144 patients were included in this study: 84 in Group A and 60 in Group B. The mean haemoglobin difference for Group A was 3.96g/dl (standard deviation [SD]: 1.52) and for Group B it was 3.46g/dl (SD: 1.42). The mean haematocrit difference for Group A was 0.12% (SD: 0.05) and for Group B it was 0.10% (SD: 0.04). Using an independent t-test for the comparison of means, a significant difference was found between Group A and B both in regards to haemoglobin difference (p=0.009) and haematocrit difference (p=0.046). CONCLUSIONS We feel that intraoperative cell salvage provides a more efficient method of reducing blood loss than postoperative retransfusion in primary total hip replacement. A prospective randomised study would be useful to ascertain any clinical difference between the two methods.
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Affiliation(s)
- L Mason
- Trauma and Orthopaedic Department, Nevill Hall Hospital, Abergavenny, UK.
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Kleinert K, Theusinger OM, Nuernberg J, Werner CM. Alternative procedures for reducing allogeneic blood transfusion in elective orthopedic surgery. HSS J 2010; 6:190-8. [PMID: 21886535 DOI: 10.1007/s11420-009-9151-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 12/01/2009] [Indexed: 02/07/2023]
Abstract
Perioperative blood loss is a major problem in elective orthopedic surgery. Allogeneic transfusion is the standard treatment for perioperative blood loss resulting in low postoperative hemoglobin, but it has a number of well-recognized risks, complications, and costs. Alternatives to allogeneic blood transfusion include preoperative autologous donation and intraoperative salvage with postoperative autotransfusion. Orthopedic surgeons are often unaware of the different pre- and intraoperative possibilities of reducing blood loss and leave the management of coagulation and use of blood products completely to the anesthesiologists. The goal of this review is to compare alternatives to allogeneic blood transfusion from an orthopedic and anesthesia point of view focusing on estimated costs and acceptance by both parties.
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Yamada T, Kasamatsu H, Fujita S, Mori H. Laparoscopy for hemoperitoneum after traditional inguinal hernia repair. JSLS 2002; 6:221-3. [PMID: 12166761 PMCID: PMC3043431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Hemoperitoneum after inguinal hernia repair, with the exception of laparoscopic herniorrhaphy, is extremely rare. No other case of hemoperitoneum after traditional open inguinal hernia repair has been reported in the English-language literature. A 39-year-old woman had undergone inguinal hernia repair with the Bassini repair technique. Lower abdominal pain and anemia occurred on postoperative day 1. Laparoscopy was performed and revealed hemoperitoneum caused as a complication of inguinal hernia repair. The abdominal cavity was thoroughly washed with saline solution, and the aspirated blood was processed and reinfused. Laparoscopy for hemoperitoneum as a complication after inguinal hernia repair was very useful for both diagnosis and treatment.
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Affiliation(s)
- Takashi Yamada
- Department of Obstetrics and Gynecology, Hirakata City Hospital, Osaka, Japan.
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Abstract
BACKGROUND Substantial blood loss and the requirement for blood transfusion remain major considerations for hepatic surgeons. We analysed the impact of a systematic protocol aimed at reducing intraoperative blood loss and homologous blood (HB) transfusion associated with hepatic resection. METHODS Prospective clinical data were collected from 151 elective liver resections performed during the period between 1980 and 1999. Further data directly related to blood loss and anaesthesia were retrospectively collected from the anaesthetic intra-operative record. Strategies implemented in 1991 included preoperative autologous blood donation, low central venous pressure anaesthesia, aprotinin administration, ultrasonic dissection, hepatic vascular inflow occlusion and a Cell Saver. Blood loss and transfusion requirements were studied before and after the implementation of these strategies. RESULTS There was no difference in the patient demographics, indications for operation or the scope of resections in the two time periods evaluated. Blood-saving strategies resulted in decreased estimated blood loss (4500 mL vs. 1000 mL p<0.001). In addition, the number of patients requiring transfusion decreased (91.8% vs. 25.5% respectively, p<0.001) and the mean number of units of HB transfusion was lower (I 3.7 vs. 2.3, p<0.001). Morbidity and mortality were also decreased (57.1% vs. 25.5%, p<0.001 and 10.2% and 4.9% p<0.001, respectively). No complications directly referrable to low CVP anesthesia were identified. CONCLUSION Systematic implementation of strategies designed to control blood loss are effective and may reduce morbidity and mortality associated with hepatic resections.
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Affiliation(s)
- Luke L Bui
- Division of General Surgery and Surgical Oncology, Department of Anaesthesia and Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Canada
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