The effect of autologous blood salvage techniques upon bank blood usage and the cost of routine coronary revascularization

Perfusion ◽  
1986 ◽  
Vol 1 (4) ◽  
pp. 239-244 ◽  
Author(s):  
Loren F Hiratzka ◽  
James V Richardson ◽  
Berkeley Brandt ◽  
Donald B Doty ◽  
Nicholas P Rossi ◽  
...  
Keyword(s):  
Coronary Revascularization ◽  
Autologous Blood ◽  
Blood Bank ◽  
Cell Saver ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
Blood Usage ◽  
Potential Risks ◽  
The Mean ◽  
The Cost

Preservation of autologous blood during cardiac surgery may reduce the need for homologous blood transfusions. We reviewed our experience for patients undergoing primary coronary revascularization to determine the effect of the use of the Haemonetics Cell-Saver upon blood bank resources and upon the cost of operation. The quantity of homologous blood required by two groups of patients was compared. One group of 46 patients had operation prior to use of the Cell- Saver ; the other group of 31 patients was entered into Cell-Saver protocols. The mean number of homologous blood units transfused per patient fell strikingly (p < 0.0001) from 4.2 before to 0.5 after introduction of the Cell- Saver. Of the 31 patients in the Cell-Saver protocol, 71 % required no homologous blood while they received 2.5 units of autologous blood processed by the Cell-Saver. Related to this, the mean number of units prepared by typing and compatibility testing in anticipation of surgery fell from 10 units to five. The projected cost to the patient fell 23%. There were no adverse effects from the use of the Cell-Saver. We conclude that the use of the Cell-Saver is justified not only to reduce the potential risks of homologous blood transfusion, but also to reduce the strain upon blood bank resources and the patient cost of primary coronary revascularization.

scholarly journals Comparison of the efficacy of autologious blood transfusion combined with preoperative hemodilution, with homologous blood transfusion in patients undergoing elective surgical procedure

2018 ◽  
Vol 5 (3) ◽  
pp. 536
Author(s):  
Sanjay Saksena ◽  
Namrata Jain ◽  
Alok Dixit
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Blood Bank ◽  
Autologous Blood Transfusion ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
Coagulation Profile ◽  
Group A ◽  
Group B ◽  
Transfusion Reactions

Background: To study the changes in haemogram and coagulation profile in patients undergoing autologous and homologous blood transfusion and suitability of the technique of autologous blood transfusion in routine blood bank management.Methods: Patients who were waiting to undergo elective surgical procedures were randomly distributed in two groups, Group A:  Autologous blood transfusion, with or without haemodilution: wherein pre-operative period a predicted volume of blood was collected and Group B: Homologous blood transfusion: where required blood was arranged from Blood Bank. The cardiovascular status, the haemogram and the coagulation profile were recorded at various stages.Results: Out of 240 patients registered only 43 could fulfil the basic requirements only 25 could be motivated in each group. In Group A cases were of age group 51-60 years while it was 41-50 years in Group B. Male:Female ratio was 2:1. 47 Units were retransfused to Group A patients, Group B cases received 45 blood transfusions. In Group A patients 8% cases showed mild hypotention and 1% showed mild hypersensitivity to Haemacel. In Group B, 40% cases showed transfusion reactions. Fall in Hb was lesser in Group A (2.4) on first and (1.7) on second postoperative day compared to Group B (3.3) on first and (2.7) on second postoperative day. The haematocrit levels declined more sharply after operation in Group B (7) rather than Group A (10.4).Conclusions: Advantage of avoiding transfusion reactions, major changes in blood parameters, entry of infections proves Autologous blood transfusion to be the safest, cost effective and easy form of transfusion therapy.

These studies indicate that homologous blood transfusion affects the outcome of clinical diseases in both beneficial and adverse ways. Experimental situations are not suitable for randomized clinical trials - transfusions cannot be given to prevent the onset of diabetes or wound strength measured in man following receipt of homologous or autologous blood. These experimental observations indicate that the outcomes of numerous clinical diseases which have not been studied may be manipulated by the use of homologous blood or that transfusion should be avoided. Several studies indicate that changes in immune function following transfusion are permanent. The number of clinical phenomena associated with immune suppression and attributable to blood transfusion is unknown. SUMMARY Given the evidence presented here it would be foolish to suggest that transfusion of homologous blood has no immunologic consequences for the recipient. Blood transfusion is the oldest form of transplant - no one would argue that transplantation between unrelated individuals has no influience on the immune system. In organ transplantation the immunologic sequelae are permanent and there is evidence that the same is true following homologous blood transfusion. Lymphocytopenia is present one year following surgery for Crohn's disease if patients receive perioperative blood transfusion (43). Colorectal cancer patients transfused more than seven years prior to diagnosis have significantly reduced numbers of lymphocytes and lower natural killer cytotoxicity than colorectal cancer patients who have never been transfused (44). Transfusion of neonates causes suppression of lymphocyte reactivity which is still demonstrable 25 to 30 years later (45). There is evidence that transfusion at any time prior to elective surgery increases susceptibility to infectious complications (14) and otherwise healthy transfused individuals may be at increased risk of developing malignancies (46). All the longterm consequences of blood transfusion are not negative: Survival of transplants is prolonged by pretransplant transfusion and some women suffering from recurrent spontaneous abortion can deliver at term if previously transfused with their spouse's leukocytes. In the future we will be able to transfuse blood without causing immune perterbations and the consequent clinical phenomena. Studies presented here suggest that removal of donor leukocytes reduces the risk of infection and cancer recurrence. The technology has not reached the point of reducing the leukocyte number in transfused blood below 10^/unit. An alternative which is increasingly being utilized is autologous blood programs. Physicians are discovering that patients tolerate hemoglobin levels which were previously unacceptably low and many patients prefer being anemic over the risks of receiving homologous blood. Since transfusion is an identifier of high cost hospitalized patients, alternatives to routine blood use are being studied in hopes of safely reducing the costs of transfusion. REFERENCES 1. Jubert AV, Lee ET, Hersh EM, McBride CM. J Surg Res 15:399-403, 1973. 2. M 19 u4n ( s3t ) e3r4A6-M 35 , 2 W , i1n9c8h1u . rch RA, Keane RM, Shatney CH, Ernst CB, Nuidema GD. Ann Surg

1995 ◽  
pp. 300-300
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Elective Surgery ◽  
Autologous Blood ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
One Year ◽  
Colorectal Cancer Patients

Since blood transfusion is linked to the magnitude of the surgical procedure, comparing transfused patients to untransfused patients will always be confounded by infection risks due to factors related to the procedure. To control for these factors one must compare patients transfused with red cells from different sources or prepared in a manner which minimize infection risk. Patients transfused with homologous blood have infection rates several fold higher than recipients of equal values of autologous blood undergoing the same operative procedure (20-23). Homologous blood recipients have significantly longer hospital stays attributed to treating infections. The cost of a blood transfusion exceeds the cost of collection, storage and administration because of transfusion's association with length of stay. In this era of cost-containment the association with prolonged stay may ultimately curtail the use of blood. Homologous blood can be filtered to remove donor leukocytes which may be contributing to immune suppression and infection risk. A prospective randomized trial comparing the infection rates among colorectal cancer patients receiving filtered and unfiltered blood has been conducted (9). There were 17 infectious complications among the 56 recipients of whole blood and one infectious complication among the 48 recipients of filtered blood. Infections were prevented by the seemingly simplistic addition of a $25/filter to every bag of blood transfused. These clinical studies are very convincing: homologous blood transfusion is associated with increased risk of infection in every clinical situation examined. In multivariate analyses transfusion was a significant predictor of infection after consideration of other variables measured and in the majority of those studies transfusion was the single most significant factor. Patients receiving homologous blood exhibited an incidence of infectious complications that was approximately four times higher than patients receiving autologous blood. The association of transfusion with infection is found among patients undergoing surgery for cardiac, orthopedic and gastrointestinal disorders and for trauma as well as among unoperated patients transfused for bums and gastrointestinal bleeding. The observation that nosocomial infections are increased in these studies argues strongly that the association of transfusion with infection is not simply a reflection of transfusion as a marker of tissue destruction and contamination. Infections that develop in transfused patients away from the site of trauma or in the absence of trauma, cannot be attributed to the quantity of tissue destroyed or to the degree of bacterial contamination. Filtered blood can remove leukocytes and prevent postoperative infections. Since filtering blood can significantly reduce the incidence of infection among transfused patients, all transfused blood will be passing through filters in the very near future. EXPERIMENTAL STUDIES RELATING BLOOD TRANSFUSION TO INCREASED RISK OF INFECTION Patients are extremely heterogeneous and even in prospective randomized trials, factors which influence patients' participation affect the outcome despite double-blinding and randomization. In animal studies using syngeneic strains with identical housing, lighting, access to food and water, control over the extent of injury, use of antibiotics and exposure to other variables the influence of a single variable such as blood transfusion can be measured. Dr. Waymack's laboratory has intensively studied parameters which interact with transfusion in

1995 ◽  
pp. 296-296
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Experimental Studies ◽  
Infection Risk ◽  
Infectious Complications ◽  
Risk Of Infection ◽  
Infection Rates ◽  
Homologous Blood ◽  
Increased Risk ◽  
The Cost

scholarly journals Decreasing the Blood Transfusion Rate in Elective Hip Replacement Surgery Using an Autologous Drainage System

2007 ◽  
Vol 89 (2) ◽  
pp. 136-139 ◽  
Author(s):  
SW Sturdee ◽  
DJ Beard ◽  
G Nandhara ◽  
SV Sonanis
Keyword(s):  
Blood Transfusion ◽  
Hip Replacement ◽  
Drainage System ◽  
Length Of Hospital Stay ◽  
Transfusion Rate ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
Drain Group ◽  
The Mean ◽  
Arthroplasty Surgery

INTRODUCTION This is a prospective study looking at the effectiveness of autologous postoperative drains in primary uncemented total hip replacement (THR) surgery. PATIENTS AND METHODS A total of 86 patients were studied, with 43 using standard suction drains (normal drain group) and 43 using autologous drains (autologous drain group). RESULTS Thirty-seven units of homologous blood were transfused in the normal drain group and 5 units in the autologous drain group. The mean number of units of homologous blood transfused per patient was reduced from 0.86 to 0.12 (P < 0.01) with the use of autologous drains and the transfusion rate was reduced from 23% to 6% (P < 0.02). The mean length of hospital stay was also reduced by two nights (P < 0.05). There were no adverse effects from using the autologous system and it does reduce the need for a homologous blood transfusion. CONCLUSIONS The system is simple and easy to use and we have also found it to be cost effective. Previously, it has not been reported as being effective in hip arthroplasty surgery, unlike knee arthroplasty surgery. We would recommend using autologous postoperative drains in primary THR surgery.

scholarly journals Frequency of homologous blood transfusion in patients undergoing cleft lip and palate surgery

2010 ◽  
Vol 43 (01) ◽  
pp. 054-059
Author(s):  
Wasiu L. Adeyemo ◽  
Mobolanle O. Ogunlewe ◽  
Ibironke Desalu ◽  
Akinola L. Ladeinde ◽  
Titilope A. Adeyemo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Cleft Palate ◽  
Teaching Hospital ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
University Teaching ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
The Mean

ABSTRACT Aim: The study aims to determine the frequency of homologous blood transfusion in patientsundergoing cleft lip and palate surgery at the Lagos University Teaching Hospital, Nigeria. Setting and Design: A prospective study of transfusion rate in cleft surgery conducted at the Lagos University Teaching Hospital, Nigeria. Material and Methods: One hundred consecutive patients who required cleft lip and palate surgery were recruited into the study. Data collected included age, sex and weight of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Each patient was made to donate a unit of homologous blood prior to surgery. Results: There were 52 females and 48 males with a mean age of 64.4 ± 101.1 months (range, 3-420 months). The most common cleft defect was isolated cleft palate (45%) followed by unilateral cleft lip (28%). Cleft palate repair was the most common procedure (45%) followed by unilateral cleft lip repair (41%). The mean estimated blood loss was 95.8 ± 144.9 ml (range, 2-800ml). Ten (10%) patients (CL=2; CP=5, BCL=1; CLP=2) were transfused but only two of these were deemed appropriate based on percentage blood volume loss. The mean blood transfused was 131.5 ± 135.4ml (range, 35-500ml). Six (60%) of those transfused had a preoperative PCV of < 30%. Only 4.9% of patients who had unilateral cleft lip surgery were transfused as compared with 50% for CLP surgery, 11% for CP surgery, and 10% for bilateral cleft lip surgery. Conclusions: The frequency of blood transfusion in cleft lip and palate surgery was 10% with a cross-match: transfusion ratio of 10 and transfusion index of 0.1. A “type and screen” policy is advocated for cleft lip and palate surgery.

Comparison of the effects of a cell saver and low-dose aprotinin on blood loss and homologous blood usage in patients undergoing valve surgery

2001 ◽  
Vol 15 (3) ◽  
pp. 326-330 ◽  
Author(s):  
Deepak K. Tempe ◽  
Amit Banerjee ◽  
Sanjula Virmani ◽  
Navneet Mehta ◽  
Sunil Panwar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Low Dose ◽  
Valve Surgery ◽  
Cell Saver ◽  
Homologous Blood ◽  
A Cell ◽  
Blood Usage

scholarly journals Intraoperative red blood cell salvage and autologous transfusion during open radical retropubic prostatectomy: a cost–benefit analysis

2011 ◽  
Vol 93 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Sarvpreet Ubee ◽  
Manal Kumar ◽  
Nallaswami Athmanathan ◽  
Gurpreet Singh ◽  
Sean Vesey
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Radical Retropubic Prostatectomy ◽  
Autologous Blood Transfusion ◽  
Cell Saver ◽  
Cell Salvage ◽  
Homologous Blood ◽  
Retropubic Prostatectomy ◽  
Group A ◽  
Group B

INTRODUCTION Open radical retropubic prostatectomy (RRP) has an average blood loss of over 1,000ml. This has been reported even from high volume centres of excellence. 1 – 4 We have looked at the clinical and financial benefits of using intraoperative cell salvage (ICS) as a method of reducing the autologous blood transfusion requirements for our RRP patients. MATERIALS AND METHODS Group A comprised 25 consecutive patients who underwent RRP immediately prior to the acquisition of a cell saver machine. Group B consisted of the next 25 consecutive patients undergoing surgery using the Dideco Electa (Sorin Group, Italy) cell saver machine. Blood transfusion costs for both groups were calculated and compared. RESULTS The mean postoperative haemoglobin was similar in both groups (11.1gm/dl in Group A and 11.4gm/dl in Group B). All Group B patients received autologous blood (average 506ml, range: 103–1,023ml). In addition, 5 patients (20%) in Group B received a group total of 16 units (average 0.6 units) of homologous blood. For Group A the total cost of transfusing the 69 units of homologous blood was estimated as £9,315, based on a per blood unit cost of £135. This cost did not include consumables or nursing costs. CONCLUSIONS We found no evidence that autologous transfusions increased the risk of early biochemical relapse or of disease dissemination. ICS reduced our dependence on donated homologous blood.

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