Effect of Autologous Blood Transfusion on Red Blood Cells in Lumbar Fusion

Blood transfusion is associated with immunosuppression, although the exact etiology of the immunosuppressive effect is not fully understood. The clinical significance of the immunosuppressive effect of blood transfusion has been examined in three situations: (1) studies of renal allograft survival after renal transplantation, (2) outcome studies in patients who have had surgical resection of solid cancer tumors, and (3) studies of infection rates in postoperative patients. In each scenario, the data support the conclusion that transfusion is associated with immunosuppression as manifested by increased renal allograft survival, increased recurrence and mortality rates in patients with cancer, and increased infection rates in postoperative patients who are transfused. Not all studies demonstrate an immunosuppressive effect of transfusion. There are several possible explanations for these discrepancies. First, prognostic variables other than transfusion itself account for the outcome results in these retrospective studies. Second, the extent of immunosuppression may be influenced by the type of blood product transfused, the amount transfused, and the timing of the transfusion; these factors have not been considered in all studies. For example, whole blood has been implicated as having a greater immunosuppressive effect than packed red blood cells, and many studies have shown that more than three units of packed red blood cells are necessary to affect outcome. Controlled animal studies have tested the hypothesis that transfusions increase solid tumor growth or the risk for infection. These studies have yielded conflicting results. Nevertheless, evidence that blood transfusion influences clinical outcome mitigates that a decision to transfuse must consider both risks and benefits of a transfusion; the possible consequences of immunosuppression must be included among the risks. Use of autologous blood, erythropoietin, and, in the future, synthetic hemoglobin may lead to improved outcome in patients with certain disease processes.

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Retrograde autologous blood priming is an efficient technique for without, or minimally usage of blood infant cardiosurgery

Medical & Clinical Research ◽

10.33140/mcr.02.01.02 ◽

2017 ◽

Vol 2 (1) ◽

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Red Blood Cells ◽

Blood Cells ◽

Autologous Blood ◽

Control Group ◽

Study Group ◽

Aortic Cross Clamp Time ◽

Transfusion Requirements ◽

Circulation Circuit

Background: Both severities of cardiac surgery and technical features of extracorporeal circulation circuit demands blood transfusion from donors, which involves a number of risks for the patient, especially with low body weight. Priming of the cardiopulmonary bypass circuit with patients’ own blood [retrograde autologous priming (RAP)] is a technique used to limit haemodilution and reduce transfusion requirements. Methods: the study included 250 children (131 boys, 119 girls) with congenital heart disease, operated on heart under CPB, weighing less than 20kg (18.45 ± 2.15) and 3.4 ± 1.7 years average age, who were divided into experimental (125 children) and control group (125children). In the control group, conventional CPB was performed (supplementing the priming with red blood cells), while in study group CPB was started after RAP via aortic cannula with recuperation till 45 % of cristaloid “priming”. The hematocrit (Hct), lactate (Lac) levels at two perioperative time-points, and intraoperative and postoperative blood usage were recorded. There were no significant differences in CPB time, aortic cross-clamp time between groups. Results: No hospital lethality occurred in the study and no surgical hemostasis was performed. Blood loss accounted for 6.2 ml/kg /24h. Postoperative transfusion of homologous blood (erythrocyte mass) needed 73 children, that make up only 29, 2 % of the whole study group. Amongst children who received transfusion on pump, the number of packed red blood cells was less in the RAP group than that in the standard priming group intraoperatively and perioperatively (0.54 ± 0.17 vs. 1.48 ± 0.68 units, P = 0.03; 0.94 ± 0.54 vs. 1.69 ± 0.69 units, P = 0.15). There were no significant differences in CPB time, aortic clamp, and Lac value between the two groups (P>0.05). Length of ICU and hospial stay were similar. Conclusions: “priming”minimalisation and autologous blood priming, modified ultrafiltration (MUF) could diminish the necessity of perioperative blood transfusion in infant cardiac surgery.

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