[Peculiarities of application of a cell saver apparatus in neonathal cardiosurgery using artificial blood circulation].

Elaborated and introduced into the practice method of the blood preservation, while correction of complex inborn heart failures (IHF) in a newborn babies, was proposed. It assumes application of system for intraoperative reinfusion of own erythrocytes with processing of residual perfusate and their reinfusion in a postperfusion period. Impact of the blood preservation on volume of a donor's blood components, hematological indices and methods of application of washed erythrocytes while correction of complex IHF in a newborn babies were presented. The method was applied in 47 newborn babies, to whom an arterial switch was performed for the main vessels transposition.

A hemolysis study of an intravascular blood cooling system for localized organ tissue cooling.

Therapeutic hypothermia can reduce both ischemic and reperfusion injury arising after strokes and heart attacks. New localized organ cooling systems offer a way to reduce tissue damage more effectively with fewer side effects. To assess initial blood safety of our new organ cooling system, the CoolGuide Cooling System (CCS), we investigated safe operating conditions and configurations from a hemolysis perspective. The CCS consists of a peristaltic pump, a custom-built external heat exchanger, a chiller, biocompatible polyvinyl cellulose (PVC) tubing, and a control console. The CCS cools and circulates autologous blood externally and re-delivers cooled blood to the patient through a conventional catheter inserted directly into the organ at risk. Catheter configurations used included: a 7F guide catheter only, a 7F guide with a 0.038" wire inserted through the center and advanced 2 cm distal to the catheter distal tip, a 6F guide catheter only and a 6F guide with a 0.014" guidewire similarly inserted through the center. Using porcine blood, an in vitro test rig was used to measure the degree of hemolysis generation, defined as the percentage change in free hemoglobin, adjusted for total hemoglobin and hematocrit, between exiting and entering blood. The highest degree of hemolysis generation was 0.11±0.04%, based on the average behavior with a 6F catheter and a 0.014" guidewire configuration at a blood flow rate of approximately 130 mL/min. In terms of average percentage free hemoglobin exiting the system, based on total hemoglobin, the highest value measured was 0.17%±0.03%, using this 6F and 0.014" guidewire configuration. This result is significantly below the most stringent European guideline of 0.8% used for blood storage and transfusion. This study provides initial evidence showing hemolysis generation arising from the CoolGuide Cooling System is likely to be clinically insignificant.

[Mechanic reinfusion in emergency surgery].

The article highlights techniques and effects of intraoperative mechanic blood reinfusion in patients with trauma and intraabdominal bleeding in extend, exceeding the self circulating blood volume. The high efficacy of the self blood reinfusion during the emergency operation allowed the 2-fold decrease of the hospital and overall mortality. The mechanic blood reinfusion proved to be a safe and clinically effective method of the globular blood volume deficiency compensation, especially in emergency surgery.

Cell saving systems do not reduce the need of transfusion in low-risk patients undergoing cardiac surgery.

OBJECTIVES: Cell saving systems have been widely used to reduce blood loss and need of transfusions. These device are mainly indicated in complex cardiac surgery procedures and in those patients with a high risk of bleeding. However, it is not clear if there is a benefit of a cell saver (CS) system in low-risk patients undergoing cardiac surgery. Our aim was to analyze if the use of CS systems reduce the need of blood products in low-risk patients undergoing cardiac surgery. METHODS: Between February and June 2009 all low-risk patients (EuroSCORE<10%) undergoing coronary or valve procedure were selected (n=63). Exclusion criteria were: combined procedure, aorta procedure, redo surgery, emergency procedures, creatinine levels>2 mg/ml, anemic patients and patients with a body surface area (BSA)<1.6 m2. Patients were randomized to undergo cardiac surgery with a cell saving system (group CS) (n=34) or without (control group, CO) (n=29). All patients received tranexamic acid during the procedure. Need of blood products and clinical outcomes were analyzed in both groups. RESULTS: Mean age was 64.7±12.3 years old with 33% of female patients. Baseline clinical characteristics and preoperative blood count cell were similar in both groups. Mean CS blood reinfused was 461±174 ml (maximum: 985 minimum: 259). A total of 59 red blood packages were transfused in 25 patients (mean 1.02±1.3; range: 0-5). The proportion of patients being transfused was similar in both groups (CS: 40% vs. CO: 46.4%; P=0.79). Eleven plasma packages were transfused (CS: 8 vs. CO: 3; P=0.77) and three platelet pools were used in group CS and none in group CO (P=0.08). Multivariate analysis showed that preoperative hemoglobin levels>13.3 g/dl [relative risk (RR): 0.29; confidence interval (CI): 0.09-0.99] and BSA>1.74 (RR: 0.19; CI: 0.54-0.68) were protective against blood transfusion. CONCLUSIONS: In low-risk patients CS system did not reduce the need of blood transfusion. Clinical outcomes were similar regardless of the use of a cell saver system. A low preoperative hemoglobin level and a low BSA were related with the use of blood products.

[Technology of blood preservation in the surgery of the abdominal aorta].

The results of surgical treatment of abdominal aortic aneurysm in 60 patients are presented. The Cell Saver was used in 22 (36.7%) patients for blood saving. The usage of the Cell Saver didn't effected the needs for red blood cells in the perioperative period.

Viability of red cells prepared with S-303 pathogen inactivation treatment.

BACKGROUND: A nucleic acid-targeted pathogen inactivation process with S-303 was developed to treat red blood cells (RBCs). STUDY DESIGN AND METHODS: Three studies in healthy subjects investigated posttransfusion recovery, life span, and immunogenic potential of autologous RBCs treated with S-303 and stored for 35 days. A two-arm trial in 42 subjects (1A) examined recovery of 35-day-old S-303 RBCs after a single transfusion. A one-arm study (1B) measured recovery and immune response in 28 subjects after multiple transfusions of S-303 RBCs. A randomized, crossover study (1C) in 29 subjects compared recovery and life span of 35-day-old S-303 RBCs and conventional RBCs. RESULTS: In Studies 1A and 1B, mean recovery of S-303 RBCs ranged from 78.7 to 84.4 percent. In Phase 1C, the mean 24-hour posttransfusion recoveries of S-303 and untreated RBCs were 81.7 +/- 6.3 and 84.5 +/- 6.2 percent (p = 0.05). The median life spans (t(1/2)) of S-303 and control RBCs were identical (37.4 days, p = 0.98). No antibodies to S-303 RBCs were detected. CONCLUSION: The mean 24-hour recovery of 35-day-old S-303 RBCs was less than untreated RBCs, but greater than 75 percent. RBCs treated with S-303 and stored for 35 days exhibited median life span not different from that of conventional RBCs.

A new practical technique to reduce allogeneic blood exposure and hospital costs while preserving clotting factors after cardiopulmonary bypass: the Hemobag.

Recent data independently linking allogeneic blood use to increased morbidity and mortality after cardiopulmonary bypass (CPB) warrants the study of new methods to employ unique and familiar technology to reduce allogeneic blood exposure. The Hemobag allows the open-heart team to concentrate residual CPB circuit contents and return a high volume of autologous clotting factors and blood cells to the patient. Fifty patients from all candidates were arbitrarily selected to receive the Hemobag (HB) therapy. A retrospective control group of 50 non-Hemobag (NHB) patients were matched to the HB group patient-by-patient for comparison according to surgeon, type of procedure, age, body surface area (BSA), body weight and CPB time. Many efforts to conserve blood (Cell Saver and ANH) were employed in both groups. Post-CPB cell washing of circuit contents was additionally employed in the control group. There were no significant differences between the HB and NHB groups in regard to patient morphology, pre-op cell concentrations, distribution of surgeon or procedures (41% valve, 16% valve/coronary artery bypass graft (CABG), balance CABG), pump and ischemic times and Bayes National Risk scores. The average volume returned to the patient from the HB was 817+/-198 mL (1 SD). Average processing time was 11 min. The Hemobag contained an average platelet count of 230+/-80 K/mm3, fibrinogen concentration of 413 +/- 171 mg/dl, total protein of 8.0+/-2.8 gm/dl, albumin of 4.4+/-1.2 gm/dl and hematocrit of 43+/-7%. Factor VII, IX and X levels in three HB contents averaged 259% greater than baseline. Substantial reductions were achieved in both allogeneic blood product avoidance and cost to the hospital with use of the HB. Infusion of the Hemobag concentrate appears to recover safely substantial proteins, clotting factor and cell concentration for all types of cardiac procedures, maintaining the security of a primed circuit.

[Possibilities and profits of blood saving in orthopedics and traumatology]. / Mozliwosci oszczedzania krwi na oddziale ortopedyczno-urazowym i wynikajace z tego korzysci.

The author presents his own experiences related to blood saving methods in orthopedics and traumatology. The analysis was carried out on 56 patients who underwent major orthopedic procedures: 35 total hip arthroplasties, 19 total knee arthroplasties and two fusions of fractures of the spine performed between the end of 1998 and the beginning of 1999. Patients were prepared for elective surgery by carrying out autotransfusion, which gave on average 2 units of blood for each patients. During the post operative period blood for retransfusion was obtained through active drainage using CBC Consta VAC (Strayker) equipment and through active drainage using standard Baxter transfusion bags. This gave approx. 350-700 ml of blood after hip arthroplasties, 500-800 ml after knee arthroplasty and 500 ml after stabilization of spine fractures. An analysis of the morphotic values of blood from CBC (Strayker) and the transfusion bags (Baxter) did not reveal any statistically significant differences. This confirmed that both methods are equally useful for obtaining blood from the post-operative wound. However, the low cost and simplicity of downward drainage make this method more suitable for our hospitals. Autotransfusion yielded in our department an annual saving of 250 l of blood and in many planned operations eliminate the necessity for allogenic blood transfusion.

[Bacterial infection within the scope of hemotherapy]. / Problematik der bakteriellen Infektion im Rahmen der Hämotherapie.

OBJECTIVE: The purpose of this article is to present a survey of bacterial infections caused by hemotherapy. DATA SOURCES: Original papers as well as review articles from international investigations based on literature data banks. RESULTS: As there exist only a few studies about transfusion complications caused by bacteria you only can find sporadic reports. Surely immunocompromised recipients have high risk to be hurt. Causing bacteria are various but Staphylococci, Yersinia, Serratia and Pseudomonas species often are found. Especially platelet concentrates give higher infection risk because storage at room temperature is obligatory. This fact makes growth conditions more comfortable. Strict hygienic measures, extension of donor screening and pointed quality control are capable to decrease the risk of transfusion complications. CONCLUSIONS: Exact indications and a clear strategy evaluating the transfusion reports and routine bacteriological control are necessary to prevent infections caused by hemotherapy.

Extracorporeal circulation as a blood conservation technique for extensive pelvic operations.

Difficult pelvic operations for malignancy or complex benign conditions can be associated with extensive blood loss. Religious beliefs that preclude transfusion and the known risks of homologous blood have prompted investigators to seek alternatives to transfusion. We used the Haemonetics-V50 Cell Separator (Haemonetics Corporation) to provide for extracorporeal circulation of the patient's own blood with associated normovolemic hemodilution as a means of conserving blood during operations. This technique was used in eight patients undergoing extensive pelvic operations. The procedure was accepted by Jehovah's Witnesses and was well tolerated by all patients. Estimated blood loss ranged from 75 to 2,000 milliliters. One instance of mild intraoperative disseminated intravascular coagulation was encountered. Two patients were given homologous transfusions. While clinical judgment is necessary to determine the safety of complicated operations, this technique is useful in expanding surgical options for some patients who object to blood transfusion.

[Essential standards of mechanical autologous donation and transfusion]. / Essentielle Standards bei apparativer autologer Spende und Transfusion.

Apparative autologous blood donation and transfusion can be performed by simple devices (Bentley ATS, Sorenson, Solcotrans) or by using cell separation and RBC-washing (Dideco, Haemonetics). Due to many problems in retransfusion of recovered whole blood, simple devices should no longer be used. By mechanical autotransfusion including cell separation and RBC-washing, an autologous RBC-concentrate of high quality is reached. Considering essential standards, mechanical autotransfusion is a safe method to reduce the risks of homologous blood transfusion.

Blood conservation in major orthopedic surgery.

During an eight-year period, intraoperative autotransfusion was performed in 1922 operations. There were 476 primary hip arthroplasties, 1017 revision hip arthroplasties, 339 spinal procedures, and 90 vascular cases. There were no known complications related to autotransfusion in any of the cases. With proper technique, red cell salvage is approximately 58% effective, and intraoperative blood loss can be reduced by that amount. The first four years' experience with the preoperative autogeneic blood program is as follows. Using a combined program of predonation and primary hip arthroplasty, 72% of the revision hip arthroplasties and 81% of the spinal instrumentations required only autologous blood. A combined program of autologous donation and intraoperative autotransfusion is an excellent alternative to allogeneic blood replacement and a means of eliminating transfusion-related disease.

[Autologous blood donation with preservation by freezing]. / Eigenblutspende mit Tiefkühlkonservierung.

Freezing of red cells has the advantage of preserving quality and viability of red blood cells. When used for autologous blood, it allows a flexible schedule of multiple preoperative donations. The main disadvantage is the need for deglycerolization before retransfusion; so frozen storage is thought to be time- and cost-intensive. The combination of predeposit autologous blood maintained in frozen storage and intraoperative blood salvage (Cell Saver) returning the autologous red cells to the patient after washing has been our routine program in orthopedic surgery for several years. Therefore, the idea arose of transferring the thawing and deglycerolization procedure to the surgical theatre in order to use the Cell Saver twice. The anesthetist takes care of the preparation of the predeposit blood according to the actual needs of the patient. One unit of washed packed predeposit red cells is available within 30 min. The intraoperative blood salvage can be performed with the same machine simultaneously without interference, as drawing of blood is still possible during the washing procedure. Since the same disposable is used for both procedures costs are saved. Using this approach cell freezing was established in our orthopedic hospital, where more than 70% of hemotherapy is now covered by autologous blood.

Autologous transfusion and the preservation of frozen red blood cells.

Freezing red blood cells for indefinite lengths of time for subsequent transfusion has become an accepted blood banking procedure. Its advantages over 35-day preserved citrated blood are reviewed and the technical aspects of freezing outlined. As the number of known hazards of homologous transfusion increases, the advantages of autologous transfusion are increasingly being recognized. The combination of frozen preservation and autologous transfusion is the ideal method of blood replacement. Plastic surgeons can frequently anticipate their blood needs in view of the large number of elective procedures, and should utilize this method of blood replacement.