scholarly journals Cell saver physics – a review

2020 ◽  
pp. S49-S54
Author(s):  
M Fourtounas
Keyword(s):  
Autologous Blood ◽  
Outer Wall ◽  
Autologous Blood Transfusion ◽  
Cell Saver ◽  
Cell Processor ◽  
Cell Salvage ◽  
Waste Products ◽  
Shed Blood ◽  
Surgical Field ◽  
Centripetal Forces

Cell salvage, cell saver, cell processor or autologous blood transfusion is the process of collecting a patient’s blood from the surgical field, washing, filtering and transfusing it back to the same patient. There are six basic steps involved in cell salvage. Step one involves the collection of shed blood into a reservoir with an anticoagulant-saline mixture. Step two is the filtration of debris and clots. In step three, the red blood cells (RBCs) are separated from the nonerythrocyte components. This process may be likened to clothes in the washing machine. Washing with saline removes contaminants in step four and the RBCs are resuspended in saline and transferred to the reinfusion bag. Waste products are transferred into the waste bag in step five. In step six, the resuspended, washed RBCs are collected in a bag at room temperature which can be reinfused. The functioning of the cell saver is based on Newton’s First and Second Laws of Motion, where centripetal forces are generated to separate the blood components depending on their density. The denser RBCs are driven to the outer wall of the centrifuge bowl with the plasma collecting on the inside. A typical yield will retrieve 50–95.8% RBCs with a final haematocrit of 50–70%. Cell savers are used in procedures with a large volume of anticipated blood loss, high risk of bleeding, low preoperative haemoglobin, in patients with rare blood groups or multiple antibodies and in some Jehovah’s Witness patients.

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.

scholarly journals Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation

2011 ◽  
Vol 93 (5) ◽  
pp. 398-400 ◽  
Author(s):  
L Mason ◽  
C Fitzgerald ◽  
J Powell-Tuck ◽  
R Rice
Keyword(s):  
Blood Loss ◽  
Hip Arthroplasty ◽  
Autologous Blood ◽  
Service Evaluation ◽  
Autologous Blood Transfusion ◽  
Cell Salvage ◽  
Total Hip ◽  
Intraoperative Cell Salvage ◽  
Group A ◽  
Group B

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.

scholarly journals 1308. Ex vivo Impact of Autologous Blood Transfusion (ABT) on Concentrations of Antibiotics used for Surgical Prophylaxis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S667
Author(s):  
Maxwell J Lasko ◽  
Allison Conelius ◽  
Oscar Serrano ◽  
David P Nicolau ◽  
Joseph L Kuti
Keyword(s):  
Ex Vivo ◽  
Autologous Blood ◽  
Plasma Concentrations ◽  
Autologous Blood Transfusion ◽  
Cell Saver ◽  
Surgical Prophylaxis ◽  
Research Support ◽  
Material Support ◽  
Drug Concentrations ◽  
Research Grant

Abstract Background ABT is widely employed during surgical procedures involving high blood loss, such as liver transplantation and open heart surgery. While ABT mitigates the need for allogeneic blood transfusions, an unintended consequence may be removal of drugs, including antimicrobials. Herein, we determined the ex vivo loss of antimicrobials utilized for surgical prophylaxis through an ABT system. Methods Experiments were conducted in duplicate to simulate processing of ABT blood during surgery. Packed red blood cells and fresh frozen plasma (300ml) were acquired from banked blood and inoculated to achieve clinically-relevant plasma concentrations of vancomycin (VAN), the piperacillin (PIP) component of piperacillin/tazobactam, and the ampicillin (AMP) component of ampicillin/sulbactam. Inoculated blood was processed through a Cell Saver® Elite™ ABT system to fill a 125mL Latham bowl and washed with 500mL of normal saline. Processed fluid was directed to a reinfusion or waste bag; additional blood samples were collected from each. Drug concentrations were measured in all samples. The amount of VAN, PIP, and AMP infused through the Cell Saver (initial), and resulting in the reinfusion and waste bags was calculated. Results A range of 193-265mL of combined blood containing drug were processed in each experiment through the ABT system. Initial average plasma concentrations were 61, 107, and 172 mg/L for VAN, PIP, and AMP, respectively. When corrected for volume and hematocrit, plasma concentrations translated to a mean ± SD of 3 ± 1% of VAN in the reinfusion bag and 93 ± 2% in the waste bag. For PIP, plasma concentrations translated to 2 ± 1% of PIP in the reinfusion bag and 84 ± 13% in waste, while 2 ± 1% and 120 ± 5% of AMP was found in the reinfusion and waste bags, respectively. Unaccounted drug (0-14%) was considered sequestered in the device. Conclusion These ex vivo assessments of antibiotic removal during ABT are the first to demonstrate significant loss of antibiotics (>95%) when processed through the ABT system. Further studies measuring impact of ABT on drug concentrations in patients undergoing surgery are warranted. Disclosures David P. Nicolau, PharmD, Cepheid (Other Financial or Material Support, Consultant, speaker bureau member or has received research support.)Merck & Co., Inc. (Consultant, Grant/Research Support, Speaker’s Bureau)Wockhardt (Grant/Research Support) Joseph L. Kuti, PharmD, Allergan (Speaker’s Bureau)bioMérieux (Research Grant or Support, Other Financial or Material Support, Speaker Honorarium)Melinta (Research Grant or Support)Merck & Co., Inc. (Research Grant or Support)Paratek (Speaker’s Bureau)Summit (Other Financial or Material Support, Research funding (clinical trials))

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

2015 ◽  
Vol 10 (5) ◽  
pp. 334-341 ◽  
Author(s):  
Pankaj Garg ◽  
Amber Malhotra ◽  
Manan Desai ◽  
Pranav Sharma ◽  
Arvind Kumar Bishnoi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Artery Bypass ◽  
Osmotic Fragility ◽  
Limiting Factor ◽  
Cell Saver ◽  
Cell Salvage ◽  
Free Hemoglobin ◽  
Surgical Field

Objective Cell Saver system is the method of choice for red blood cell salvage from the surgical field; however, cost is a limiting factor. We at our institute have devised a cost-effective version of dialyser-based autotransfusion system. We performed pretransfusion comparison of our autotransfusion system with conventional cell saver system. Methods A prospective randomized observational study was performed in 104 consecutive patients with coronary artery disease undergoing by off-pump coronary artery bypass grafting. Patients were divided into two groups. In the dialyser group (53 patients), blood from surgical field was salvaged by our dialyser-based system. In the cell saver group (51 patients), blood was salvaged by cell saver. In both groups, 20-mL sample from the salvaged blood was analyzed for hemoglobin, platelets, protein, albumin, free hemoglobin, osmotic fragility, and peripheral blood smear examination. Results Total hemoglobin salvaged was comparable in both groups (85% vs 76%). On peripheral smear, red blood cells were swollen, but morphology was preserved. Moreover, normal osmotic fragility suggested absence of any lethal damage to red blood cells in either group. Dialyser-based system was more efficient in salvaging platelets (42.9% vs 6%), proteins (79.2% vs 0%), and albumin (65% vs 0%). Total free hemoglobin was three times more in dialyser group but was well below recommended limits. Conclusions Dialyser-based system is economical, is equally efficacious in salvaging red blood cells, is more effective in salvaging platelets and proteins, and does not contain significant amount of free hemoglobin. Therefore, this salvaged blood can be safely transfused.

scholarly journals Intraoperative cell salvage: A technology built upon the failures, fads and fashions of blood transfusion

2019 ◽  
Vol 47 (3_suppl) ◽  
pp. 17-30
Author(s):  
Michelle Roets ◽  
David J Sturgess ◽  
Kerstin Wyssusek ◽  
André A van Zundert
Keyword(s):  
Blood Transfusion ◽  
Literature Review ◽  
Treatment Modality ◽  
Autologous Blood ◽  
Autologous Blood Transfusion ◽  
Cell Salvage ◽  
Allogeneic Transfusion ◽  
Intraoperative Cell Salvage

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.

Experience of Autologous Blood Transfusion at a District General Hospital in Zambia

1994 ◽  
Vol 24 (3) ◽  
pp. 108-111 ◽  
Author(s):  
Winfred Manda ◽  
Gillian Duffy
Keyword(s):  
Blood Transfusion ◽  
Adverse Effects ◽  
Autologous Blood ◽  
District General Hospital ◽  
Autologous Blood Transfusion ◽  
Cell Salvage ◽  
Central Hospital ◽  
Autologous Transfusion ◽  
Practical Guidelines ◽  
Immunological Reactions

SUMMARY An Autologous Blood Transfusion Programme has been in operation at Ndola Central Hospital (NCH) since April 1992. This paper describes a method of cell salvage and reviews the two types of autologous transfusion [acute isovolaemic haemodilution (AIH) and cell salvage] practised over the 6 month period November 1992 to April 1993. No complications or adverse effects were encountered and the benefits include reduction of immunological reactions and transmission of infection, which are risks associated with homologous transfusion. There is need to minimize homologous transfusions because of these risks and hospitals should develop reasonable, practical guidelines for safer transfusion, including the use of autologous blood whenever possible.

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