scholarly journals Evaluation of the Feasibility of Transfusing Leucocyte Depletion Filter (LDF) Processed Intra-Operative Cell Salvage (IOCS) Blood in Metastatic Spine Tumour Surgery (MSTS): Protocol for a Non Randomised study (Preprint)

2019 ◽  
Author(s):  
Naresh Kumar ◽  
Jiong Hao Tan ◽  
Nivetha Ravikumar ◽  
Joel Yong Hao Tan ◽  
Helena Milavec ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Disease Progression ◽  
Tumour Progression ◽  
Rank Test ◽  
Control Group ◽  
Healthcare Intervention ◽  
Cell Salvage ◽  
Blood Management ◽  
Metastatic Spine Tumour Surgery ◽  
Spine Tumour

BACKGROUND Metastatic Spine Tumour Surgery (MSTS) is often complex and extensive leading to significant blood loss. Allogeneic blood transfusion (ABT) is mainstay of blood replenishment but with immune-mediated post-operative complications. Alternative blood management techniques (salvaged blood transfusion (SBT)) allow us to overcome such complications. Despite widespread use of intra-operative cell salvage (IOCS) in oncological and non-oncological surgeries, surgeons remain reluctant to employ IOCS in MSTS. OBJECTIVE This study will analyse the safety of IOCS-LDF processed blood transfusion to patients undergoing MSTS by assessing clinical outcomes – disease progression: tumour progression and overall survival (OS). We will also evaluate whether reinfusion of IOCS-LDF processed blood can reduce the ABT rates in patients undergoing MSTS by comparing the proportion of MSTS patients requiring ABT in those patients who consent to receive SBT, and those who do not consent for SBT. METHODS We aim to recruit 90-patients (minimum)-30 SBT, 30 ABT and 30 with no blood transfusion (NBT). SBT and ABT form the two experimental arms, while NBT forms the control cohort. All available patient data will be reviewed to determine tumour burden secondary to metastasis and post-operative survival and/or disease progression, improvement in pain, neurology and ambulatory status. Collected data will be studied at 3, 6, 12 and 24 months post-operatively, or until demise, whichever occurs first. Collected outcomes of the experimental groups will be compared with that of the control group. Statistical Analysis: Outcomes will be analysed using one-way ANOVA and Fisher’s exact test. OS will be studied by Kaplan-Meier curve and log rank test. Multivariate and competing risk analysis will be used to study the association between blood transfusion type and tumour progression. All statistical analyses will be done using STATA/SE14.0 RESULTS This is the first clinical study on the use of IOCS in MSTS from various primary malignancies. It will provide major clinical evidence regarding safety and applicability of IOCS in MSTS. It will help reduce ABT usage; thus improving overall blood management of MSTS patients. However, limitation of this study is that not all patients undergoing MSTS will survive for the total follow-up period (two years), thereby theoretically leading to under-reporting of disease progression. CONCLUSIONS Results will be disseminated via peer-reviewed publications and will pave the way for future studies CLINICALTRIAL This study did not involve a healthcare intervention and hence, did not need to be registered

scholarly journals Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa: A retrospective cohort analysis

2019 ◽  
Author(s):  
Yushan Ma ◽  
Xi Luo ◽  
Xuemei Lin ◽  
xiaoqin Jiang ◽  
Hui Liu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Group Versus ◽  
Control Group ◽  
Transfusion Rate ◽  
Cell Salvage ◽  
Blood Management ◽  
Donor Blood ◽  
Uterine Incision

Abstract Background Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS. Methods This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), while 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin(Hb) and hematocrit (HCT). In addition, the baseline conditions of mother and neonates were compared. Results The EBL was significantly higher in the IIA group compared to the control group (2883.5 ML in the IIA group versus 1868.7 ML in the control group, P=0.001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 ml, in the IIA group versus 20%, averaging 816.7 ml, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 ml. In the control group, 90% had salvaged blood returned, averaging 617.9 ml. No cases of amniotic fluid embolism were observed with leukocyte depletion filters. Conclusion Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.

Metastatic spine tumour surgery: does perioperative blood transfusion influence postoperative complications?

2017 ◽  
Vol 17 (3) ◽  
pp. S17-S18
Author(s):  
Aye Sandar Zaw ◽  
Dhiraj Sonawane ◽  
Karthikeyan Maharanjan ◽  
Dennis Hey ◽  
Aravind Kumar ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Metastatic Spine Tumour Surgery ◽  
Spine Tumour ◽  
Perioperative Blood Transfusion

Intraoperative cell salvage in metastatic spine tumour surgery reduces potential for reinfusion of viable cancer cells

2016 ◽  
Vol 25 (12) ◽  
pp. 4008-4015 ◽  
Author(s):  
Naresh Kumar ◽  
Aye Sandar Zaw ◽  
Bee Luan Khoo ◽  
Sayantani Nandi ◽  
Zhangxing Lai ◽  
...  
Keyword(s):  
Cancer Cells ◽  
Cell Salvage ◽  
Intraoperative Cell Salvage ◽  
Metastatic Spine Tumour Surgery ◽  
Spine Tumour

scholarly journals Effectiveness of Intraoperative Cell Salvage Combined with a Modified Leucocyte Depletion Filter in Metastatic Spine Tumour Surgery

2022 ◽  
Author(s):  
Ya-nan Zong ◽  
Chuan-ya Xu ◽  
Yue-qing Gong ◽  
Xiao-qing Zhang ◽  
Hong Zeng ◽  
...  
Keyword(s):  
Tumour Cells ◽  
Residual Tumour ◽  
Cell Salvage ◽  
Clinical Trial Registry ◽  
Blood Samples ◽  
Intraoperative Cell Salvage ◽  
Significant Difference ◽  
Metastatic Spine Tumour Surgery ◽  
Leucocyte Depletion Filter ◽  
Spine Tumour

Abstract Background To compare the effectiveness of intraoperative cell salvage (IOCS) combined with a modified leucocyte depletion filter (MLDF) with IOCS combined with a regular leucocyte depletion filter (RLDF) in eliminating tumour cells from blood salvage during metastatic spine tumour surgery (MSTS). Methods Patients with a known primary epithelial tumour who underwent MSTS were recruited for this study. Blood samples were collected in 5 stages: from the patients’ vein before anaesthesia induction (S1), from the operative field during tumour manipulation (S2), and from the operative blood after IOCS processing (S3) and after IOCS+RLDF (S4) and IOCS+MLDF (S5) processing. The polyploids of tumour cells in the blood samples were collected and counted with immunomagnetic separation enrichment and fluorescence in situ hybridization. Results We recruited 20 patients. Tumour cells were detected in 14 patients (70%) in S1, 16 patients (80%) in S2, 13 patients (65%) in S3, and 12 patients (60%) in S4. MLDF was added in 8 patients. Tumour cells were detected in only 1 of 8 patients in S5 (12.5%). There were significantly fewer tumour cells in the samples collected after MLDF processing (S5) than in the samples collected after RLDF (S4) and around the tumour (S2) (P = 0.016 and P = 0.039, respectively). Although no significant difference was observed between S4 and S1, a downward trend was observed after IOCS+RLDF processing. Conclusions Tumour cells could be removed by IOCS combined with RLDF from blood salvaged during MSTS, but residual tumour cells remained. The findings support the notion that MLDF eliminates tumour cells more effectively than RLDF. Hence, this technique can be applied to MSTS. Trial Registration ChiCTR1800016162 Chinese Clinical Trial Registry http://www.chictr.org.cn/showproj.aspx?proj=27263

The Use of Cell Salvage During Second-stage Reimplantation for the Treatment of Chronic Hip Periprosthetic Joint Infection: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Zunhan Liu ◽  
Xuetao Yang ◽  
En-Ze Zhao ◽  
Xufeng Wan ◽  
Guorui Cao ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Control Group ◽  
Published Data ◽  
Cell Salvage ◽  
Two Stage ◽  
Reinfection Rate ◽  
Second Stage ◽  
Intraoperative Cell Salvage

Abstract Introduction Given the possibility of undetectable infection, the use of cell salvage is relatively contraindicated in cases of reimplantation for chronic hip periprosthetic joint infection (PJI). However, there is no published data supporting this assertion. The purpose of the current study was to compare the reinfection rate and rate of in second-stage reimplantation for PJI with or without intraoperative cell salvage reinfusion.Materials and methods We identified 125 patients who underwent two-stage exchange for chronic hip PJI between November 2012 and April 2019. The groups of patients who had and had not received intraoperative cell salvage reinfusion were compared with respect to the curative infection-free rate and need for postoperative ABT. We identified independent factors associated with ABT using multiple regression analysis.Results The log-rank survival curve with an endpoint of infection eradication failure was not significantly different between the cell salvage group (98.4%, 95% CI 95.3-99.9%) and the control group (95.3%, 95% CI 90.2-99.9%) at one year (log rank, P = .330). Meanwhile, the rates of postoperative ABT in the cell salvage group were significantly lower than those in the control group (11.5% vs 26.6%, P = .041). In multivariable models, patient age, body mass index (BMI), preoperative haemoglobin level, and intraoperative cell salvage were independent predictors of ABT exposure (P < .05).Conclusions The use of cell salvage during reimplantation in two-stage exchange for chronic hip PJI did not appear to increase the reinfection rate, while it significantly reduced the rate of postoperative allogeneic red blood transfusion. Greater age, lower BMI, lower preoperative haemoglobin, and non-intraoperative cell salvage reinfusion were associated with higher rate of allogeneic red blood transfusion.

scholarly journals The safety, efficacy and cost-effectiveness of intraoperative cell-salvage in metastatic spine tumour surgery

2016 ◽  
Vol 16 (4) ◽  
pp. S61-S62
Author(s):  
Mahmoud Elmalky ◽  
Naveed Yasin ◽  
Ricardo Pinto ◽  
John Stephenson ◽  
Craig Carroll ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cell Salvage ◽  
Intraoperative Cell Salvage ◽  
Metastatic Spine Tumour Surgery ◽  
Spine Tumour

scholarly journals A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial

2018 ◽  
Vol 22 (2) ◽  
pp. 1-88 ◽  
Author(s):  
Khalid S Khan ◽  
Philip Moore ◽  
Matthew Wilson ◽  
Richard Hooper ◽  
Shubha Allard ◽  
...  
Keyword(s):  
At Risk ◽  
Caesarean Section ◽  
Blood Transfusion ◽  
Intervention Group ◽  
Cost Effective ◽  
Routine Care ◽  
Control Group ◽  
Transfusion Rate ◽  
Cell Salvage ◽  
Donor Blood

BackgroundCaesarean section is associated with blood loss and maternal morbidity. Excessive blood loss requires transfusion of donor (allogeneic) blood, which is a finite resource. Cell salvage returns blood lost during surgery to the mother. It may avoid the need for donor blood transfusion, but reliable evidence of its effects is lacking.ObjectivesTo determine if routine use of cell salvage during caesarean section in mothers at risk of haemorrhage reduces the rates of blood transfusion and postpartum maternal morbidity, and is cost-effective, in comparison with standard practice without routine salvage use.DesignIndividually randomised controlled, multicentre trial with cost-effectiveness analysis. Treatment was not blinded.SettingA total of 26 UK obstetric units.ParticipantsOut of 3054 women recruited between June 2013 and April 2016, we randomly assigned 3028 women at risk of haemorrhage to cell salvage or routine care. Randomisation was stratified using random permuted blocks of variable sizes. Of these, 1672 had emergency and 1356 had elective caesareans. We excluded women for whom cell salvage or donor blood transfusion was contraindicated.InterventionsCell salvage (intervention) versus routine care without salvage (control). In the intervention group, salvage was set up in 95.6% of the women and, of these, 50.8% had salvaged blood returned. In the control group, 3.9% had salvage deployed.Main outcome measuresPrimary – donor blood transfusion. Secondary – units of donor blood transfused, time to mobilisation, length of hospitalisation, mean fall in haemoglobin, fetomaternal haemorrhage (FMH) measured by Kleihauer–Betke test, and maternal fatigue. Analyses were adjusted for stratification factors and other factors that were believed to be prognostic a priori. Cost-effectiveness outcomes – costs of resources and service provision taking the UK NHS perspective.ResultsWe analysed 1498 and 1492 participants in the intervention and control groups, respectively. Overall, the transfusion rate was 2.5% in the intervention group and 3.5% in the control group [adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.42 to 1.01;p = 0.056]. In a planned subgroup analysis, the transfusion rate was 3.0% in the intervention group and 4.6% in the control group among emergency caesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 1.8% in the intervention group and 2.2% in the control group among elective caesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interactionp = 0.46, suggesting that the difference in effect between subgroups was not statistically significant). Secondary outcomes did not differ between groups, except for FMH, which was higher under salvage in rhesus D (RhD)-negative women with RhD-positive babies (25.6% vs. 10.5%, adjusted OR 5.63, 95% CI 1.43 to 22.14;p = 0.013). No case of amniotic fluid embolism was observed. The additional cost of routine cell salvage during caesarean was estimated, on average, at £8110 per donor blood transfusion avoided.ConclusionsThe modest evidence for an effect of routine use of cell salvage during caesarean section on rates of donor blood transfusion was associated with increased FMH, which emphasises the need for adherence to guidance on anti-D prophylaxis. We are unable to comment on long-term antibody sensitisation effects. Based on the findings of this trial, cell salvage is unlikely to be considered cost-effective.Future workResearch into risk of alloimmunisation among women exposed to cell salvage is needed.Trial registrationCurrent Controlled Trials ISRCTN66118656.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 22, No. 2. See the NIHR Journals Library website for further project information.

PENGARUH PEMBACAAN DZIKIR PADA IBU MELAHIRKAN TERHADAP TINGKAT NYERI INTRA NATAL DI RUMAH BERSALIN FAJAR YOGYAKARTA

2010 ◽  
Vol 1 (1) ◽  
Author(s):  
Sri Sumaryani ◽  
Indri Nurasa
Keyword(s):  
Home Delivery ◽  
Labor Pain ◽  
Rank Test ◽  
Control Group ◽  
Pain Level ◽  
Control Group Design ◽  
Signed Rank ◽  
Wilcoxon Signed Rank Test ◽  
Post Test ◽  
Signed Rank Test

PENGARUH PEMBACAAN DZIKIR PADA IBU MELAHIRKAN TERHADAP TINGKAT NYERI INTRA NATAL DI RUMAH BERSALIN FAJAR YOGYAKARTAEffect of Reading Dhikr Women On The Level Of Birth Pain Intra Christmas At Home Delivery Dawn YogyakartaSri Sumaryani1 & Indri Nurasa21, 2)Program Studi Ilmu Keperawatan Fakultas Kedokteran Universitas Muhammadiyah YogyakartaJl. Lingkar Barat Taman Tirto Kasihan Bantul Yogyakarta 55182*)e-mail: [email protected] atau yang biasa disebut dengan proses persalinan merupakan suatu proses membuka dan menipisnya serviks, dan janin turun ke dalam jalan lahir. Gejala awal persalinan akan menimbulkan nyeri yang sangat hebat karena adanya kontraksi uterus dan otot abdomen. Nyeri intra natal adalah suatu nyeri yang dirasakan saat terjadinya proses persalinan (melahirkan). Saat nyeri persalinan muncul, ada baiknya bagi ibu untuk membaca dzikir. Dzikir adalah mengingat Allah SWT dan menghadirkan apa yang tadinya ada di dalam benak untuk kemudian dilafadzkan atau disebut-sebut yang dapat dilakukan secara lisan dengan menggunakan lidah atau bisa juga diucapkan tanpa adanya keterlibatan lidah, yaitu melalui hati. Penelitian ini bertujuan untuk mengetahui pengaruh pembacaan dzikir pada ibu melahirkan terhadap tingkat nyeri intra natal. Teknik pengambilan sampel menggunakan purposive sampling. Desain penelitian pra eksperimen, dengan rancangan pre test-post test tanpa kelompok kontrol. Sampel penelitian berjumlah 30 responden. Pengumpulan data dilakukan dengan observasi langsung kepada responden untuk mengukur tingkat nyeri. Analisa data menggunakan uji statistik wilcoxon signed rank test dan regresi linier dengan menggunakan SPSS 14. Hasil penelitian menunjukkan bahwa hasil uji statistik untuk nilai pre test dan post test tingkat nyeri diperoleh nilai signifikansi 0,02 dengan p < 0,05.Kata kunci: pembacaan dzikir, melahirkan, nyeri intra natal, tingkat nyeriABSTRACTThe delivery or usually called labor process is a process open and thin the cervix, and descent of the fetus into the way of birth. The early symptom of delivery will be appearing very heavy because there are uterus contraction and abdomen muscle. In partum pain is a pain which feel when delivery process happening (labor). When labor pain appears, there is a good for the mother to read dzikir. Dzikir is remembering Allah SWT and make present what before in the mind and then pronounced or make cal can do spoken by tongue or pronounced without there are involving tongue, by heart. The purpose of this research is to know about the influence of reading dzikir to the delivery mother toward in partum level of pain. Technique sampling used purpose sampling. The research of design pre experiment, with pre test-post test without control group design. The sample in this research’s total is 30 respondents. The manner of data was did by direct observation to the respondents to measure pain level. Data analysis used statistic test wilcoxon signed rank test and regression linier in SPSS 14. The results of research showed that results of the statistic pretest and posttest of pain level show significance value 0,02 with p < 0,05.Keywords: reading dzikir, delivery, in partum pain, pain level

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