Blood preservation techniques in complex spine surgery: Illustrative case and review of therapeutic options

Background: Complex spine surgery predisposes patients to substantial levels of blood loss, which can increase the risk of surgical morbidity and mortality. Case Description: A 29-year-old achondroplastic male required thoracolumbar deformity correction. However, he refused potential allogeneic blood transfusions for religious reasons. He, therefore, underwent pre-operative autologous blood donation and consented to the use of the intraoperative cell salvage device. Immediately prior to the incision, he underwent acute normovolemic hemodilution. Throughout the case, we additionally utilized meticulous hemostasis. Postoperatively, he was supplemented with iron and erythropoietin and recovered well. When he required a revision procedure 3 months later, similar strategies were successfully employed. Conclusion: Numerous strategies exist pre-operatively, intraoperatively, and post-operatively to optimize blood loss management for patients who refuse blood transfusions but warrant major spinal deformity surgery.

Field blood preservation and DNA extraction from wild mammals: methods and key factors for biodiversity studies

Studies on public health and wild mammal biodiversity include a genetic component. For blood samples, there must be optimal sample collection conditions since these can affect DNA preservation and extraction. This study evaluated the use of liquid and dry DNA preservation methods and commercial and non-commercial DNA extraction methods on field-collected blood samples. For this, 264 total blood samples were collected from wild mammals. A first group of samples was preserved in guanidine hydrochloride (GuHCl) and DNA was extracted using six commercial kits: Bioline, Norgen, Invitrogen, Promega, and Qiagen, in addition to phenol-chloroform isoamyl alcohol (PC) and guanidine thiocyanate (GIT). Another group of samples was preserved in Whatman® FTA® cards and DNA was extracted with PC and GIT. The extractions with GIT and PC showed the highest values (ng/µL) and variation in DNA concentration, while the commercial kit showed low variation. Sample preservation in Whatman® FTA® cards provided low variation and quantity of the extracted DNA compared with the use of GuHCl. Concerning DNA quality, the commercial kits yielded higher purity, while GIT and PC-based protocols provided highly variable results. Furthermore, the use of GIT and PC yielded a higher amount of DNA, yet, of variable quality. Overall, extraction based on commercial kits and Whatman® FTA® preservation allowed obtaining more standardized DNA qualities and quantities.

An active transport refrigerator is optimal for blood preservation in small medical facilities

Objective: In small medical institutions in Japan, red blood cell (RBC) solutions are commonly stored in household refrigerators because of the high cost of blood-only refrigerators. Therefore, we assessed and compared the methods used for preserving the RBC solutions in an active transport refrigerator (ATR), a blood-only refrigerator, and a household refrigerator. Materials and Methods: Irradiated RBC solution samples (280 mL) supplied by the Japanese Red Cross Society (experiments 1–8) and in-house whole blood waste (experiments 9–10) were each divided into two bags. The quality of blood stored in an active transport refrigerator was compared with that of blood stored in a blood-only refrigerator or a household refrigerator. We tested the hemolytic effects of storage and filtration through a transfusion set on the lactate dehydrogenase ratio (LDR) of the RBC solutions. Results: Although the LDR of the RBC solutions stored in the ATR was similar to that of the RBC solutions stored in the blood-only refrigerator, the LDR of the RBC solutions stored in the household refrigerator was significantly higher than that of the RBC solutions stored in the ATR. Conclusion: Temperature management using an ATR is critical for the maintenance of the quality of the RBC solution, which is not achieved by a household refrigerator.

Organization, current state and immediate prospects of the problem «bloodless surgery»

The research focus of the publication is the problem of preserving the blood of the operated patient. The variety of blood preservation methods shows the multidisciplinary nature of the problem and the importance of well-coordinated teamwork of busy doctors. For more than 20 years, surgical, anesthetic, transfusion technologies of blood saving have been used mainly in cardiac surgery patients. The use of a complex of blood-saving technologies allows you to reduce the amount of blood loss and the consumption of donor blood components. Over 7 years in cardiac surgery, the number of recipients of donor hemocomponents decreased by 41% (erythrovesue) and 61% (FFP). Autologous plasma is 68-78% of the total volume transfused to cardiac patients. 50% of patients operated on the ascending aorta do not need a blood transfusion. Blood loss during extensive liver resections has decreased three times in 10 years and does not require allogeneic blood transfusions. An adequate multidisciplinary approach to solving the problem of blood conservation can improve the results of surgical treatment of patients.

The blood preservation in surgical treatment of the mitral disease of the heart

Objective. Investigation of modern possibilities of the bloodless technique of surgical treatment of the mitral valve failure (МVF) in environment of artificial blood circulation (ABC). Маterials and methods. There were examined 727 patients, suffering MVF. All the patients were divided into two groups: the main and a comparative one. The main group have consisted of 637 patients, in whom various variants of the blood preservation without its transfusion were applied, without application of a cell-saver, hemoconcentrating columns and the blood ultrafiltration; and a comparative one group have consisted of 90 patients, to whom the blood preparations were transfused. The procedure depicted have provided the anesthesia and the perfusion measures during operation of the mitral valve change, including аs well the peculiarities of the intraoperative infusion therapy management in the ABC conditions. Results. In the main group of patients the rate of postoperative infectious complications have constituted 1.2%, while in a comparative one - 9.9%. Median duration of stay on the artificial pulmonary ventilation have constituted (6.7 ± 2.3) and (12.3 ± 8.4) hours accordingly. The average duration of stay in reanimation department was (58.4 ± 12.4) and (116.3 ± 45.2) hours, accordingly (р < 0.05). The intraoperative blood loss volume in the main group was significantly lesser, than in a comparative one: (261.2 ± 33.8) and (533.1 ± 131.6) ml, accordingly (р < 0.05). On all stages of the operation and in postoperative period the level of hemoglobin have persisted in a compensation period range, what constitutes a safe level of the blood oxygen capacity. Conclusion. Introduction of intraoperative variants of the autologous blood reservation without application of the donor’s blood, сеll-saver and hemoconcentration columns is not accompanied with lowering of the oxygen delivery and consumption, as well as development of lactate-acidosis. The improved procedure of anesthesiological support consisted of the infusion-transfusion therapy conduction with stimulation of diuresis, the water balance control, applying combination of an acute normovolemic hemodilution with ABC, and lowering of hemodilution due to retrograde filling of oxygenator by autologous blood. As well there were applied various methods of the autologous blood exfusion and its components combinations, change of tactics in the infusion hemostatic therapy; a central venous pressure control and support of median arterial pressure. Introduction of the procedure depicted have guaranteed a good clinical effect without complications of transfusion on a hospital stage of the patients’ management.