Tag: intra operative cell

Intraoperative cell salvage: a fresh look at the indications and contraindications

by mediconepal

August 23, 2016

Introduction Numerous approaches are used to avoid transfusion of allogeneic blood. Primary methods include, but are not limited to, erythropoietin ...

Introduction Numerous approaches are used to avoid transfusion of allogeneic blood. Primary methods include, but are not limited to, erythropoietin and iron supplementation, preoperative autologous donation, acute normovolaemic haemodilution, haemoglobinbased blood substitutes and infusible oxygencarrying fluids, and the use of cell salvage systems. While currently unavailable in North America and Europe because of an increased risk of myocardial infarction and death , research continues in the areas of haemoglobinbased blood substitutes and infusible oxygencarrying liquids. Of the accepted strategies mentioned above, cell salvage offers the medical community a safe, resourcesaving, and relatively inexpensive method to avoid allogeneic red cell transfusion. Currently, incorrect information and misconceptions regarding the use of cell salvage systems frequently portray them as expensive, ineffective, and inappropriate for use in certain clinical situations. In addition to addressing these misconceptions, this article will discuss indications and contraindications for the use of such systems. Indications In the past, the AABB (formerly known as the American Association of Blood Banks) has recommended the following general indications for cell salvage use: the anticipated blood loss is 20% or more of the patient’s estimated blood volume; crossmatchcompatible blood is unobtainable; the patient is unwilling to accept allogeneic blood, but will give consent to receive blood from intraoperative blood salvage, as in the case of Jehovah’s witnesses; more than 10% of patients undergoing the procedure require transfusion; the mean transfusion for the procedure exceeds one unit . These recommendations are derived from a cost comparison between administering allogeneic blood and use of cell salvage. More recently, the cost of administering allogeneic blood has grown, which changes this economic relationship. At the same time, the medical community has gained a much better understanding of the expense associated with cell salvage. For this reason, implementation of cell salvage should be considered when much smaller amounts of blood loss are anticipated. Because of the difficulty associated with the accurate prediction of substantial blood loss and the possible need for allogeneic transfusion, for the majority of cases it would be appropriate to set up the cell salvage device in a “standby” mode. This “standby” mode is simply the collection system which includes a cardiotomy reservoir, a suction line and an anticoagulant. The cost of a collection or “standby” setup is comparable to that of the reagents for crossmatching two units of allogeneic blood. While being a sizeable paradigm shift, hospitals might consider implementation of a “standby” setup rather than “type and cross”. In cases in which substantial blood loss is certain to occur, such as in a repair of an open thoracoabdominal aneurysm repair, it is reasonable to bypass the “standby” setup and proceed directly to preparing components necessary to process blood. READ MORE HERE http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096856/

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