Assessment of the need for routine intraoperative cell salvage in liver transplantation

Purpose: This study aimed to assess the necessity of routine intraoperative cell salvage in liver transplantations. Methods: A total of 327 liver transplants performed between 2014 and 2016 was included in the analysis. Patient data, including pre-transplant examinations, intraoperative red blood cell transfusions, and procedural information, were collected. Results: The median age of the patients was 54 years old, with 67% (219) being male. The most prevalent ABO blood type was O, accounting for 48% (155) of cases. The leading causes of liver disease were hepatitis C (113 cases, 34.6%) and alcohol-related liver disease (97 cases, 29.7%). Out of the 327 liver transplants, allogeneic red blood cell transfusions were administered in 110 cases (34%) with a median of two units of red blood cells per case. Cell salvage was employed in 237 transplants (73%), and successful blood recovery was achieved in 221 cases (93%). Among the group that recovered more than 200 mL of blood, the median volume of recovered blood was 417 mL, with no transfusion of allogeneic blood required. A total of 90 transplants was performed without utilizing cell salvage, and, among these cases, 19 required blood transfusions, with a median of zero units transfused. Conclusions: This study suggests that routine cell salvage is unnecessary for all liver transplantations. The most suitable indication for its use is in patients presenting with portal vein thrombosis and abnormal creatinine levels.

Intraoperative blood salvage in proximal femur epiphysiolysis surgical treatment with hip controlled dislocation technique: a case series study.

OBJECTIVES: To report a case series of Intraoperative Blood Salvage (IOS) in surgeries during the treatment for Slipped Capital Femoral Epiphysis (SCFE) with controlled dislocation of the hip, identifying its efficacy, complications, and the profile of patients with SCFE. METHODS: Descriptive study reporting a case series, comprising patients seen between January 2016 and March 2018, diagnosed with SCFE, and treated with controlled surgical dislocation of the hip using IOS. RESULTS: Sample comprised of 15 patients, with a mean age of 13.1 years. The most affected side was the left with 8 cases. None of the patients required allogeneic blood in the postoperative period. Mean pre- and postoperative hemoglobin were 13.2 and 11.2 g.dL-1, respectively, and mean hemoglobin difference was 1.8 g.dL-1. Mean pre- and postoperative hematocrit were 39.13% and 33.20%, respectively, and mean hematocrit difference was 5.52%. No intraoperative complications were observed. One patient presented vomiting and another one, wound infection in the postoperative period. CONCLUSION: IOS was an alternative blood salvage approach and prevented allogeneic blood transfusion, enabling reduction of potential complications.

Laparoscopic splenectomy and pericardial devascularization with artery pressure perfusion / 中国医师杂志

Objective:To evaluate trans-artery pressure perfusion autologous transfusion for laparoscopic splenectomy and pericardial devascularization (LSPD).Methods:The clinical data of patients with laparoscopic splenectomy in Zhejiang Provincial People′s Hospital in recent 3 years were reviewed. The therapeutic effects of 30 LSPD cases with trans-artery pressure perfusion (observation group) and 30 radical LSPD cases (control group) were compared and analyzed.Results:There was no significant difference in age, sex, preoperative liver function grade and spleen volume between the two groups ( P>0.05). All 60 patients completed laparoscopic splenectomy without conversion to laparotomy or death. There was no significant difference in liver function, operation time and intraoperative bleeding between the observation group and the control group ( P>0.05), and there was also no significant difference in blood transfusion, postoperative complications and hospital stay ( P>0.05). The hemoglobin level in the observation group was significantly higher than that in the control group ( P<0.05). Conclusions:Laparoscopic splenectomy and pericardial devascularization with trans-artery pressure perfusion autologous transfusion can increase post-operative hemoglobin value effectively.

Evaluation the application of intra-operative cell salvage in cesarean section based on multicenter data / 中华妇产科杂志

Objective:To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section.Methods:A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. The risk factors of intraoperative blood loss ≥1 500 mL using IOCS transfusion were analyzed by logistic multivariate regression.Results:(1) A total of 848 001 ml of blood was recovered and a total of 418 649 ml of blood was transfused in 1 265 pregnant women who received IOCS transfusions, which was equivalent to 23 258 U red blood cell suspension, greatly saving medical resources. The intraoperative blood loss in <1 500 ml group and ≥1 500 ml group was 800 ml (300-1 453 ml) and 2 335 ml (1 500-20 000 ml), respectively. No amniotic fluid embolism, severe adverse reactions, shock and death occurred in the two groups. (3) Multivariate regression analysis showed that age ≥35 years ( OR=1.5, 95% CI: 1.1-1.9), prenatal hemoglobin level <110 g/L ( OR=1.7, 95% CI: 1.3-2.2), history of uterine surgery ( OR=1.8, 95% CI: 1.3-2.6), placenta previa ( OR=1.9, 95% CI: 1.1-3.1), placenta accreta ( OR=2.6, 95% CI: 1.8-3.9), blood pool in the placenta ( OR=1.6, 95% CI: 1.1-2.3), abnormal posterior placenta muscle wall ( OR=1.8, 95% CI: 1.2-2.6), placenta projecting to the anterior uterine wall ( OR=3.0, 95% CI: 1.3-7.0) were risk factors for blood loss ≥1 500 ml in obstetric transfusion using IOCS technique, with statistical significance (all P<0.05). Conclusion:IOCS is safe and effective in cesarean section, which could save the medical resources and reduces medical expenses, however, it is necessary to strictly master the application indication.

Comparison of efficacy of two blood transfusion methods in cesarean delivery / 中国基层医药

Objective:To explore the application value and complications of two blood transfusion methods used for cesarean delivery.Methods:Sixty parturients undergoing cesarean delivery in Yiwu Central Hospital from January 2013 to December 2019 were included in this study. They were divided into autogenic blood transfusion and allogeneic blood transfusion groups ( n = 30/group) according to different blood transfusion methods used. In the autogenic blood transfusion group, self-storage blood transfusion scheme was used, while in the allogeneic blood transfusion group, allogeneic blood transfusion scheme was used. The amount of postpartum blood loss, amount of autogenic blood transfused, amount of allogeneic blood transfused, hemoglobin, hematocrit and coagulation index before and 3 days after surgery, complications were compared between autogenic blood transfusion and allogeneic blood transfusion groups. Results:Postoperative blood loss in the autogenic blood transfusion group was significantly less than that in the allogeneic blood transfusion group [(9 897.42 ± 215.37) mL vs. (23 081.87 ± 546.23) mL, t = 122.990, P < 0.05]. The amount of autogenic blood transfused in the autogenic blood transfusion group was less than that in the allogenic blood transfusion group [(954.32 ± 143.42) mL vs. (10 474.18 ± 376.87) mL, t = 129.310, P < 0.05). Hemoglobin level and hematocrit at 3 days after surgery in the autogenic blood transfusion group were (106.32 ± 12.19) g/L and (0.39 ± 0.19), which were significantly higher than those in the allogenic blood transfusion group [(86.18 ± 3.25) g/L, 0.34 ± 0.14, t = 8.744, 11.633, both P < 0.05]. D-Dimer and fibrin degradation product levels in the autogenic blood transfusion group were (5.45 ± 1.29) mg/L and (13.42 ± 2.41) mg/L, respectively, which were significantly lower than those in the allogenic blood transfusion group [(8.56 ± 1.47) mg/L, (21.30 ± 3.64) mg/L, t = 8.710, 9.887, P < 0.05]. The incidence of complications in the autogenic blood transfusion group was significantly lower than that in the allogenic blood transfusion group [6.67% (2/30) vs. 36.67% (11/30), χ2 = 7.954, P < 0.05]. Conclusion:Autogenic blood transfusion is highly effective for cesarean delivery of dangerous placenta previa, and it has few complications.

[Application of autologous platelet-rich plasma separation in cardiac valve replacement: a random clinical trial].

Objective: To examine the blood protective effect of autologous platelet-rich plasma separation for cardiac valve replacement under cardiopulmonary bypass. Methods: Sixty patients who underwent cardiac valve replacement under cardiopulmonary bypass from August 2018 to May 2019 in Shanghai Chest Hospital, Shanghai Jiao Tong University were randomly divided into control and treatment groups(each 30 cases). There were 33 males and 27 females, aged (52.0±8.4) years (range: 35 to 65 years). Autologous platelet separation was performed in the treatment group after anaesthesia administration and was completed before systemic heparinisation. Platelet separation was not performed in the control group. The thromboelastogram, blood routine, blood coagulation, perioperative fluid infusion, allogeneic blood transfusion, postoperative pleural fluid volume and postoperative fibrinogen were recorded before the operation, and 1 hour and 24 hours post operation. The two groups' data was compared by t test, Kruskal-Wallis test, Mann-Whitney U test or χ(2) test. Repeated measurement analysis of variance was used to compare platelet and coagulation indexes at different times. Results: The perioperative red blood cell transfusion of 0, 1~2, 3~4,>4 units with 6, 11, 1, 12 cases in treatment group and 14, 8, 6, 2 cases in control group (Z=-2.516, P=0.012). The postoperative fibrinogen of 0, 1, 2 units with 19, 2, 9 cases in treat group and 26, 2, 2 cases in control group (Z=-2.190, P=0.029). There was no significant difference in the cost of blood transfusion between the two groups during admission ((1 732±1 275) yuan vs. (1 176±941) yuan; t=-1.570, P=0.125). Conclusion: The use of autologous platelet-rich plasma separation can reduce the amount of allogeneic blood transfusion during valvular surgery under cardiopulmonary bypass.

[Safety of cell salvage in tumor surgery : Systematic review with meta-analysis]. / Sicherheit der maschinellen Autotransfusion in der Tumorchirurgie : Systematisches Review mit Metaanalyse.

BACKGROUND: Allogeneic blood transfusion is avoidable in many oncological interventions by the use of cell salvage or mechanical autotransfusion (MAT). As irradiation is elaborate and expensive, the safety of leucocyte depletion filters (LDF) for autologous blood from the surgical field might be a more acceptable alternative for the prevention of cancer recurrences. A previous meta-analysis could not identify an increased risk of cancer recurrence. The aim of this review article is to provide an update of a previous meta-analysis from 2012 as well as a safety analysis of cell salvage with LDF due to the improved data situation. MATERIAL AND METHODS: This systematic review included all studies in PubMed, Cochrane, Cochrane Reviews and Web of Science on cell salvage or autotransfusion combined with outcomes, e.g. cancer recurrence, mortality, survival, blood transfusion, length of hospital stay (LOS) after the use of MAT without irradiation and with or without LDF. The grades of recommendations (GRADE) assessment of underlying evidence was applied. RESULTS: A total of seven new observational studies and seven meta-analyses were found that compared unfiltered or filtered cell salvage with autologous predeposition, allogeneic transfusion or without any transfusion. No randomized controlled trials have been completed. A total of 27 observational and cohort studies were included in a meta-analysis. The evidence level was low. The risk of cancer recurrence in recipients of autologous salvaged blood with or without LDF was reduced (odds ratio, OR 0.71, 95% confidence interval, CI 0.58-0.86) as compared to non-transfused subjects, allogeneic or predeposited autologous transfusion. The transfusion rate could not be assessed due to the substantial selection bias and large heterogeneity. Cell salvage does not change mortality and LOS. Leucocyte depletion studies reported a removal rate of cancer cells in the range of 99.6-99.9%. CONCLUSION: Randomized controlled trials on a comparison of MAT and allogeneic blood transfusion as well as LDF and irradiation would be desirable but are not available. From observational trials and more than 6300 subjects and various tumors, cell salvage in cancer surgery with or without LDF appears to be sufficiently safe. The efficacy of leucocyte depletion of autologous salvaged blood is equivalent to irradiation. Unavailability of radiation is not a contraindication for cell salvage use in cancer surgery. By usage of leucocyte depleted salvaged autologous blood, the risks of allogeneic transfusion can be avoided.

Bacteremia in the red blood cells obtained from the cell saver in patients submitted to heart surgery / Bacteremia nos glóbulos vermelhos obtidos do "cell saver" em pacientes submetidos a cirurgia cardíaca / Bacteriemia en los glóbulos rojos obtenidos del "cell saver" en pacientes intervenidos de cirugía cardíaca

Objective: to determine the microbiological characteristics of the red blood cells obtained with the cell saver in heart surgery patients on an extra-body circuit. Method: a cross-sectional and descriptive study conducted with 358 patients scheduled for heart surgery where the saver was used. Sociodemographic variables were collected, as well as from the saver and of the microbial identification in the re-infusion bag proceeding from the cell saver. Informed consent performed. Results: of the 170 GRAM+ bacteria isolations, the most frequent species were Staphylococcus epidermidis in 69% (n=138) of the cases and Streptococcus sanguinis with a report of 10% (n=20). Significant differences were found in the Staphylococcus epidermidis strain in patients with a Body Mass Index ≥25 (p=0.002) submitted to valve surgery (p=0.001). Vancomycin was the antimicrobial which resisted the Staphylococcus epidermidis strain with a minimum inhibitory concentration of >16 µg/ml. Conclusion: the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis. Consequently, in order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol.

Objetivo: determinar as características microbiológicas dos glóbulos vermelhos obtidos com o "cell saver" em pacientes submetidos à cirurgia cardíaca em circuito extracorpóreo. Método: estudo descritivo transversal com 358 pacientes de cirurgia cardíaca em que o "cell saver" foi utilizado. Foram coletadas variáveis sociodemográficas e identificação microbiana da bolsa de reinfusão do "cell saver". Foi confirmado o Termo de Consentimento. Resultados: das 170 baterias isoladas GRAM+, as mais frequentes foram Staphylococcus epidermidis em 69% (n=138) dos casos e Streptococcus sanguinis com um registro de 10% (n=20). Diferenças significativas foram encontradas na cepa Staphylococcus epidermidis em pacientes com índice de massa corporal ≥25 (p=0,002) submetidos a cirurgia valvular (p=0,001). A vancomicina foi o antimicrobiano resistente à cepa Staphylococcus epidermidis com uma concentração inibitória mínima >16 µg/ml. Conclusão: as características microbiológicas dos glóbulos vermelhos obtidas após o processamento do sangue autólogo recuperado com o "cell saver" em cirurgia cardíaca são de origem bacteriana GRAM+, sendo a espécie mais isolada o Staphylococcus epidermidis. Portanto, para reduzir a presença desses cocos GRAM+, um antibiótico deve ser adicionado ao "cell saver", de acordo com um protocolo previamente estabelecido.

Objetivo: determinar las características microbiológicas de los glóbulos rojos obtenidos con el "cell saver" en el paciente de cirugía cardíaca bajo un circuito extracorpóreo. Método: estudio descriptivo transversal con 358 pacientes programados para cirugía cardíaca donde se utilizó el "cell saver". Se recogieron variables sociodemográficas e identificación microbiana de la bolsa de reinfusión procedente del "cell saver". Consentimiento informado realizado. Resultados: de 170 aislamientos de bacterias GRAM+, las especies más frecuentes fueron el Staphylococcus epidermidis en el 69% (n=138) de los casos y el Streptococcus sanguinis con un reporte del 10% (n=20). Se encontraron diferencias significativas en la cepa Staphylococcus epidermidis en pacientes con índice de masa corporal ≥25 (p=0,002) sometidos a cirugía valvular (p=0,001). La vancomicina fue el antimicrobiano resistente a la cepa Staphylococcus epidermidis con una concentración mínima inhibitoria >16 ug/ml. Conclusión: las características microbiológicas de los glóbulos rojos obtenidos tras el procesamiento de sangre autóloga recuperada con el "cell saver" en cirugía cardíaca son de origen bacteriano GRAM+ siendo la especie más aislada el Staphylococcus epidermidis. Por ello, con el fin de reducir la presencia de estos cocos GRAM+ se debería añadir un antibiótico en el reservorio del "cell saver", según un protocolo previamente establecido.

Is Intraoperative Blood Cell Salvage Effective in Hip Surgery?

Objective The present study aims to evaluate the efficacy of blood cell salvage (CS) as a method of reducing allogeneic blood transfusion in patients submitted to transtrochanteric femoral and hip surgeries due to injury. Methods Prospective cohort of 38 patients from a school hospital submitted to hip or trochanteric surgeries and divided into two groups from August 2015 to February 2017. Patients with any malignancy or infectious condition were excluded from the study. Cell savage group (19 patients) received autologous blood using cell saver, whereas control group (19 patients) received just allogeneic blood, if needed. Red blood cell parameters, blood transfusion requirements, and clinical and surgical characteristics, such as age, gender, ASA scale and type of surgery, were compared both preoperatively and postoperatively. Data was processed in SPSS 20.0. Results There were no differences in the clinical parameters studied (age, gender and ASA scale). Red blood cell parameters on the first day postoperative were higher in the cell savage group ( p < 0.05). No significant reduction of intraoperative and postoperative allogeneic blood transfusion requirements was found. Conclusion This study found that CS was not effective in reducing intraoperative and postoperative allogeneic blood transfusion requirements in patients submitted to transtrochanteric femoral and hip surgery.

Is Intraoperative Blood Cell Salvage Effective in Hip Surgery? / A recuperação intraoperatória de células sanguíneas é eficaz em cirurgias de quadril?

Abstract Objective The present study aims to evaluate the efficacy of blood cell salvage (CS) as a method of reducing allogeneic blood transfusion in patients submitted to transtrochanteric femoral and hip surgeries due to injury. Methods Prospective cohort of 38 patients froma school hospital submitted to hip or trochanteric surgeries and divided into two groups from August 2015 to February 2017. Patients with any malignancy or infectious condition were excluded from the study. Cell savage group (19 patients) received autologous blood using cell saver, whereas control group (19 patients) received just allogeneic blood, if needed. Red blood cell parameters, blood transfusion requirements, and clinical and surgical characteristics, such as age, gender, ASA scale and type of surgery, were compared both preoperatively and postoperatively. Data was processed in SPSS 20.0. Results There were no differences in the clinical parameters studied (age, gender and ASA scale). Red blood cell parameters on the first day postoperative were higher in the cell savage group (p < 0.05). No significant reduction of intraoperative and postoperative allogeneic blood transfusion requirements was found. Conclusion This study found that CS was not effective in reducing intraoperative and postoperative allogeneic blood transfusion requirements in patients submitted to transtrochanteric femoral and hip surgery.

Resumo Objetivo O estudo visa avaliar a eficácia da recuperação intraoperatória de sangue (RIOS) na redução de hemotransfusão alogênica em pacientes submetidos à cirurgia por fratura de fêmur e quadril. Métodos Coorte prospectiva com 38 pacientes submetidos a cirurgia traumatológica para fraturas em quadril e transtrocantéricas de fêmur, divididos em dois grupos em um hospital de ensino de agosto de 2015 a fevereiro de 2017. Pacientes com qualquer enfermidade ou condição infecciosa foram excluídos do presente estudo. O grupo RIOS (19 pacientes) recebeu sangue autólogo com a utilização de Cell Saver, enquanto o grupo controle (19 pacientes) recebeu apenas sangue alogênico, quando necessário.. Grupos comparados em relação ao gênero, idade na cirurgia, escala da Sociedade Americana de Anestesiologistas (ASA) (I, II ou III), uso intraoperatório da RIOS, volume sanguíneo reinfundido pela RIOS, parâmetros hematimétricos pré- e pósoperatórios, volume intra e pós-operatório de sangue alogênico transfundido. Dados processados no software SPSS Statistics for Windows, Versão 20.0 (IBM Corp, Armonk, NY, EUA). Resultados Sem diferenças significativas entre os grupos com as variáveis: idade, gênero e ASA. Percebeu-se que os valores finais de hemoglobina e hematócrito (no 1° dia de pós-operatório) foram mais elevados no grupo que utilizou o dispositivo (p < 0,05). Não houve redução significativa da transfusão alogênica intra e pósoperatória no grupo RIOS em comparação ao controle. Conclusões O presente estudo constatou que a RIOS não foi eficaz em reduzir a transfusão alogênica no intra e pós-operatório de pacientes submetidos à cirurgia de fêmur transtrocantérica e de quadril.

Effect of autologous whole blood injections on expression of FcεRI and CD63 on basophils in patients with refractory chronic spontaneous urticaria and positive autologous serum skin test / 中华皮肤科杂志

Objective To evaluate the clinical efficacy of autologous whole blood injections (AWBI) combined with antihistamines for the treatment of patients with refractory chronic spontaneous urticaria and positive autologous serum skin test (ASST),to evaluate its effect on the expression of the high-affinity IgE receptor (FcεR Ⅰ) and CD63 on basophils,and to analyze the possible mechanism underlying the treatment of ASST-positive chronic urticaria with AWBI.Methods Eighty patients with ASST-positive chronic intractable urticaria were enrolled from Department of Dermatology,The First Hospital Affiliated to Army Medical University between November 2017 and June 2018,and randomly and equally divided into two groups by a random number table:AWBI group and control group were both conventionally treated with oral loratadine and ebastine,and AWBI group were additionally treated with AWBI once a week for 12 sessions.Before the treatment and after 12-week treatment,urticaria activity score of 7 days (UAS7) and dermatology life quality index (DLQI) in the two groups were evaluated.Among 30 patients in the AWBI group,flow cytometry was performed to determine the expression of FcεRⅠ and CD63 on the basophils in the peripheral blood at the baseline,weeks 4,8 and 12 after the initial treatment.Statistical analysis was carried out with GraphPad Prism 7.00 software by t test for the comparison of UAS7 or DLQI scores,Mann-Whitney U test for the comparison of FcεR Ⅰ α expression,paired Wilcoxon signed rank test for comparing FceR Ⅰ α or CD63 expression between two different time points,and Spearman correlation analysis for analyzing the correlation between FcεR Ⅰ α and CD63 expression.Results Before the treatment,no significant differences in UAS7 or DLQI scores were observed between the AWBI group and control group (UAS7:27.15 ± 4.53 vs.26.90 ± 5.22;DLQI:16.88 ± 6.01 vs.17.08 ± 6.79;both P ＞ 0.05).After 12-week treatment,UAS7 and DLQI scores both significantly decreased in the two groups compared with those before the treatment (all P ＜ 0.01),and were significantly lower in the AWBI group than in the control group (UAS7:14.25 ± 7.56 vs.19.93 ± 6.32;DLQI:8.48 ± 4.15 vs.13.93 ± 5.43;both P ＜ 0.01).At the baseline,weeks 4,8 and 12 after the initial treatment,the fluorescence intensities of FcεR Ⅰα on basophils (M [P25,P75]) in the AWBI group were 22 532 (16 740,29 220),16 911 (10 240,21 816),13 282 (7 600,16 848) and 11 466 (7 161,14 578) respectively,and the proportions of CD63+ basophils induced by ASST-positive serum (M [P25,P75]) in the AWBI group were 35.25％ (26.75％,49.13％),25.95％ (19.37％,37.54％),13.57％ (7.79％,19.57％) and 9.87％ (6.43％,16.52％) respectively.At week 4 after the initial treatment,the expression of FcεR Ⅰα and CD63 on basophils in the AWBI group both significantly decreased compared with those at the baseline (both P ＜ 0.01),but significantly increased compared with those at week 8 (both P ＜ 0.01).The changes in FcεR Ⅰ α expression from baseline to week 4,from week 4 to week 8,and from week 8 to week 12 were positively correlated with the changes in CD63 expression induced by ASST-positive serum (r =0.364,0.422,0.455,respectively,all P ＜ 0.05).Conclusion AWBI combined with antihistamines can improve the clinical symptoms of ASST-positive refractory chronic urticaria,likely by affecting the expression of FcεR Ⅰ and CD63 on basophils.

Changes in hemoglobin profile reflect autologous blood transfusion misuse in sports.

The changes in hemoglobin (Hb) profile following autologous blood transfusion (ABT) for the first time were studied for anti-doping purposes. Twenty-four healthy, trained male subjects (aged 18‒40) were enrolled and randomized into either the transfusion (T) or control (C) groups. Blood samples were taken from the T subjects at baseline, after withdrawal and reinfusion of 450 ml of refrigerated or cryopreserved blood, and from C subjects at the same time points. Hematological variables (Complete blood count, Reticulocytes, Immature Reticulocytes Fraction, Red-cell Distribution Width, OFF-hr score) were measured. The Hb types were analyzed by high-performance liquid chromatography and the Hemoglobin Profile Index (HbPI) arbitrarily calculated. Between-group differences were observed for red blood cells and reticulocytes. Unlike C, the T group, after withdrawal and reinfusion, showed a significant trend analysis for both hematological variables (Hemoglobin concentration, reticulocytes, OFF-hr score) and Hb types (glycated hemoglobin-HbA1c, HbPI). The control charts highlighted samples with abnormal values (> 3-SD above/below the population mean) after reinfusion for hematological variables in one subject versus five subjects for HbA1c and HbPI. A significant ROC-curve analysis (area = 0.649, p = 0.015) identified a HbA1c cut-off value ≤ 2.7% associated to 100% specificity of blood reinfusion (sensitivity 25%). Hemoglobin profile changed in trained subjects after ABT, with abnormal values of HbA1c and HbPI in 42% of subjects after reinfusion. Future studies will confirm the usefulness of these biomarkers in the anti-doping field.

[Novel aspects of the guidelines for hemotherapy 2017 : Implications for anesthesiology]. / Novelle der Hämotherapierichtlinien 2017 : Implikationen für die Anästhesiologie.

Based on the German Transfusion Law, the periodically updated guidelines "Richtlinien zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten" ("Hämotherapierichtlinien") are intended to provide the current knowledge and state of the art of blood transfusion practice in Germany. The novel update 2017 contains relevant changes for blood donation, especially the extension of the exclusion period of persons at risk for sexually transmitted HBV, HCV and HIV diseases to 12 months. Moreover, the guidelines provide several changes relevant to blood transfusion practice in anesthesiology, such as: all autologous hemotherapy procedures including normovolemic hemodilution, cell saver, and autologous blood donation and transfusion require formal registration at the regulatory authority. A special detailed protocol is required for every cell saver use. A formal quality control procedure for cell saver use is necessary at least every 3 months. Retransfusion of unprocessed shed blood is generally not permitted. Guidance is provided for the clinical situation of lacking consent for blood transfusion in emergency situations (under certain circumstances blood transfusion may still be allowed). For the first time, the concept of "patient blood management" is explicitly mentioned and recommended in the guidelines. Especially the novel regulations regarding autologous blood use impose new challenges in clinical practice in anesthesiology.

Effect of storage autologous blood component transfusion versus storage autologous whole blood transfusion on cellular immune function and hemorheology in patients undergoing spinal surgery / 中华麻醉学杂志

Objective To compare the effect of storage autologous blood component transfusion versus storage autologous whole blood transfusion on the cellular immune function and hemorheology in the patients undergoing spinal surgery.Methods Forty patients of both sexes,aged 32-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective multilevel spinal surgery,were divided into 2 groups (n =20 each) using a random number table:stored autologous whole blood transfusion group (group A) and stored autologous blood component transfusion group (group B).Before blood sampling (T0),immediately after blood sampling (T1) and at the end of surgery (T2),arterial blood samples were collected for determination of red blood cell count (RBC),hemoglobin (Hb),hematocrit (Hct),erythrocyte aggregation index (EAI) and erythrocyte rigidity index (ERI).Venous blood samples were collected at T0,T2 and on day 6 after surgery (T3),the distribution of T lymphocyte subsets (percentage of CD3+,CD4+ and NK cells) was measured,and CD4+/CD8+ ratio was calculated.Results Compared with the baseline at T0,the percentage of CD3+,CD4+ and NK cells and CD4+/CD8+ ratio were significantly decreased at T2,3 in group A and at T2 in group B,and RBC,Hb and Hct were significantly decreased at T1,and EAI and ERI were decreased at T1,2 in two groups (P＜0.05).Compared with group A,the percentage of CD3+,CD4+ and NK cells and CD4+/CD8+ ratio were significantly increased at T3 (P＜0.05),and no significant change was found in RBC,Hb,Hct,EAI or ERI at each time point in group B (P＞0.05).Conclusion The effect of storage autologous blood component transfusion on cellular immune function is mitigated than that of storage autologous blood transfusion and the effects on hemorheology are comparable in the patients undergoing spinal surgery.

Influence of intraoperative blood salvage on surgery for scoliosis / Influência da recuperação intraoperatória de sangue em cirurgias para escoliose / Influencia de la recuperación intraoperatoria de la sangre en cirugía para la escoliosis

ABSTRACT Objective: To evaluate the effectiveness of intraoperative blood salvage (IBS) in reducing allogeneic transfusion in patients undergoing surgery for scoliosis. Methods: Retrospective case-control study with 69 patients who underwent surgical treatment for scoliosis correction from August 2008 to December 2014 in a teaching hospital. We used the IBS in 43 patients and it was not used in 26. The groups were compared according to the medical records, and the data were processed on SPSS 20.0. For the associations between the variable IBS and non-IBS and the independent variables we applied the χ 2 and the likelihood ratio tests, and the strength of which was calculated by their 95% CI. The means were compared by Student's t and Mann-Whitney tests. The confidence level was 0.05. Results: There were no significant differences between groups with the variables age, sex, preoperative weight, postoperative blood drainage and surgical time. There was a significant reduction of intraoperative allogeneic transfusion in the IBS group submitted to posterior arthrodesis compared with the control group, with no difference in the transfusion of red blood cells between the two groups postoperatively. In the 24 patients who underwent combined arthrodesis, there was no significant difference in allogeneic transfusion in the intra- and postoperative periods between the groups. Conclusion: The system proved to be effective in reducing allogeneic transfusion during surgery in patients undergoing posterior arthrodesis for scoliosis, but it was not effective in reducing allogeneic transfusion in the intra- and postoperative periods of those undergoing combined arthrodesis.

RESUMO Objetivo: Avaliar a eficácia da recuperação intraoperatória de sangue (RIOS) na redução da transfusão alogênica em pacientes submetidos à cirurgia para escoliose. Métodos: Estudo retrospectivo de caso-controle, com 69 pacientes submetidos a tratamento cirúrgico corretivo para escoliose, de agosto de 2008 a dezembro de 2014, em hospital-escola. Utilizou-se a RIOS em 43 pacientes e não foi usada em 26. Os grupos foram comparados conforme os prontuários, e os dados foram processados no SPSS 20.0. Nas associações entre a variável RIOS e não-RIOS e as variáveis independentes aplicaram-se os testes do χ2 e de razão de verossimilhança, sendo a força dessas calculada pelo seu IC de 95%. As médias foram comparadas pelos testes t de Student e de Mann-Whitney. O nível de confiança foi 0,05. Resultados: Não houve diferenças significativas entre os grupos com as variáveis idade, sexo, peso pré-operatório, drenagem sanguínea pós-operatória e tempo cirúrgico. Evidenciou-se redução significativa da transfusão alogênica intraoperatória no grupo RIOS submetido à artrodese posterior em comparação com o grupo-controle, sem diferença na transfusão de concentrado de hemácias entre os dois grupos no pós-operatório. Nos 24 pacientes submetidos à artrodese combinada, não houve diferença significativa na transfusão alogênica no intra e no pós-operatório entre os grupos. Conclusão: O sistema revelou-se eficaz em reduzir a transfusão alogênica no intraoperatório de pacientes submetidos à artrodese posterior para escoliose, mas não foi eficaz em reduzir a transfusão alogênica no intra e no pós-operatório daqueles submetidos à artrodese por via combinada.

RESUMEN Objetivo: Evaluar la eficacia de la recuperación de sangre intraoperatoria (RSI) en la reducción de la transfusión alogénica en pacientes sometidos a cirugía para la escoliosis. Métodos: Estudio retrospectivo de casos y controles, con 69 pacientes sometidos a cirugía correctora de la escoliosis, entre agosto de 2008 y diciembre de 2014 en un hospital universitario. Se utilizó la RSI en 43 pacientes y no se utilizó en 26. Los grupos se compararon según los datos de los registros médicos y los datos fueron procesados en el programa SPSS 20.0. En las asociaciones entre la variable RSI y no-RSI y las variables independientes se aplicaron las pruebas de χ2 y la razón de verosimilitud, siendo la fuerza de éstas calculada por su IC de 95%. Los promedios se compararon mediante la pruebas de la t de Student y de Mann-Whitney. El nivel de confianza fue de 0,05. Resultados: No se observaron diferencias significativas entre los grupos en las variables edad, sexo, peso preoperatorio, drenaje de sangre postoperatoria y tiempo quirúrgico. Se mostró una reducción significativa de la transfusión alogénica durante la cirugía en el grupo RSI sometido a la artrodesis posterior en comparación con el grupo de control, sin diferencia en la transfusión de células rojas de la sangre entre los dos grupos después de la operación. En los 24 pacientes que se sometieron a la artrodesis combinada, no hubo diferencia significativa en la transfusión alogénica en el intra y postoperatorio entre los grupos. Conclusión: El sistema ha demostrado su eficacia en la reducción de la transfusión alogénica durante la cirugía en pacientes sometidos a artrodesis posterior para la escoliosis, pero no fue efectivo en la reducción de la transfusión alogénica en el intra y postoperatorio en los que se sometieron a la artrodesis por vía combinada.

Effect and safety of intraoperative cell salvage during cesarean section / 中华围产医学杂志

Objective To assess the safety and effect of intraoperative cell salvage (ICS) during cesarean section.Methods This was a case-control study in which 60 gravidas who received ICS (ICS group) and 60 gravidas who received allogenic transfusion (control group) during caesarean section in Obstetrics and Gynecology Hospital of Fudan University during January 2014 to December 2016 were enrolled.Subjects in the two groups were matched in age,gestational age,gestational complications (placenta increta,placenta previa,scarred uterine,leiomyomas and anemia) and hemorrhagic volume during cesarean section.Several indicators including complications of transfusion,postoperative recovery,expense of transfusion,as well as the complete blood count and body temperature before and after operation were compared between the two groups.T,rank-sum or Chi-square test was used for statistical analysis.Results (1) No significant difference in age,gestational age,twin gestation,complications,preoperative body temperature,or the volume of hemorrhage or transfusion was observed between the two groups (all P＞0.05).(2) The autotransfusion volume was 385 (161-583) ml in the ICS group.Fifteen cases (20.0％) in the ICS group also received additional transfusions of leukocyte-reduced red blood cell (RBC) suspension,fresh frozen plasma and cryoprecipitate and two cases (3.3％) received additional transfusions of leukocyte reduced RBC suspension and fresh frozen plasma.The two groups showed no significant difference in the cost of transfusion or per-capita transfusion volume of fresh frozen plasma or cryoprecipitate.However,the transfusion volume of leukocyte-reduced RBC suspension was lower in the ICS group as compared with that in the control group [M(P25-P75),1.9 (1.5-4.5) vs 4.1 (2.8-6.2) U,Z=-2.800,P=0.005].(3) There was no significant difference in complete blood count or coagulation function between the two groups before the operation.White blood cell (WBC) counts in the two groups were elevated following operation.Postoperative WBC count in the control group was higher than that in the ICS group,while the levels of RBC and hemoglobin were lower than those in the ICS group following operation (all P＜0.05).(4) No amniotic fluid embolism was reported in the two groups.Only one case of rash was reported in the ICS group,which was fewer than the transfusion reactions occurred in the control group [1.7％ (1/60) vs 13.3％ (8/60),x2=5.886,P=0.016].(5) The two groups showed no significant difference in preoperative temperature,the highest temperature within three days after operation or incision healing.Compared with the patients in the control group,those in the ICS group had shorter hospital stay [(4.7± 1.1) vs (6.3 ±1.8) d,t=3.341,P＜0.05].Conclusion ICS is a safe and effective measure for gravidas at higher risk of hemorrhage during cesarean section.

Topical tranexamic acid versus autotransfusion after total knee arthroplasty.

PURPOSE: To compare the use of topical tranexamic acid (TXA) with postoperative autologous transfusion (PAT) in terms of blood loss, need for allogeneic blood transfusion, and cost-effectiveness. METHODS: Records of 25 men and 125 women (mean age, 67 years) who underwent primary unilateral total knee arthroplasty (TKA) and were randomised to the PAT group (n=50), topical TXA group (n=50), or routine drainage group (control) [n=50] were reviewed. Pre- and post-operative haemoglobin level, total postoperative drainage volume, and the need for allogeneic blood transfusion were recorded. RESULTS: The 3 groups were comparable in terms of age, gender, and preoperative haemoglobin level. The total postoperative drainage volume was lower in the TXA group than the PAT or routine drainage groups (174.48 vs. 735 vs. 760 ml, p<0.001). The postoperative haemoglobin level was lower in the routine drainage group than the PAT or TXA groups on day 1 (11.67 vs. 12.33 vs. 12.40 g/dl, p<0.001) and day 3 (9.9 vs. 10.7 vs. 11.14 g/dl, p<0.001). The number of patients who received allogeneic blood transfusion was higher in the routine drainage group (12 and 4 patients received 1 and 2 units of blood, respectively) than the PAT group (4 patients received 1 unit of blood) or the TXA group (none required transfusion) [p<0.001], and the respective total transfusion cost was $1200, $240, and $0. The total cost was lowest in the TXA group followed by the routine drainage group and PAT group ($200 vs. $1200 vs. $12 390). No patient developed acute infection, deep venous thrombosis, pulmonary embolism, myocardial infarction, or stroke. CONCLUSION: Compared with PAT, topical TXA was more cost-effective and resulted in less total postoperative drainage volume and less need for allogeneic blood transfusion.

Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery.

OBJECTIVE: To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. MATERIAL AND METHODS: A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. RESULTS: The processed shed volume was very low (939±569ml) with high variability (coefficient of variation=0.6), unlike the recovered volume 129±50ml (coefficient of variation=0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11±5.3g dl(-1); haematocrit: 32.1±15.4% (lower than expected); white cells 5.34±4.22×103 ul(-)1; platelets 37.88±23.5×103 ul(-1) (mean±SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (-) was isolated. CONCLUSIONS: Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery.

A restrospective analysis of intraoperative cell salvage during cesarean delivery / 中华麻醉学杂志

Intraoperative cell salvage ( IOCS) was conducted during cesarean delivery from May 2011 to April 2016 in our hospital: when the volume of autologous blood collected from the surgical field≥800 ml during surgery and the parturients′hemoglobin≤100 g∕L after hemorrhage, the autologous blood was centrifuged, concentrated, washed and then filtered using a leucocyte depletion filter before reinfusion. IOCS was carried out in 1 085 cases during cesarean delivery within 5 yr. For the parturients who underwent IOCS, the percentage of patients who did not require transfusion of allogeneic red blood cells was 82.95%(900 cases), the percentage of patients who required plasma transfusion was 41.66% (452 cases), the percentage of patients who required platelet transfusion was 3.32% (36 cases), and no autologous blood transfusion?related adverse reactions were found during surgery and hospital stay. In conclusion, IOCS could be safely and effectively used for blood?saving effect in cesarean delivery.

Comparison of effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in patients undergoing cesarean section / 中华麻醉学杂志

Objective To compare the effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in the patients undergoing cesarean section.Methods Sixty patients,aged 20-35 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective cesarean section,were randomly divided into 2 groups (n =30 each) using a random number table:hemodiluted autotransfusion group (group HAT) and allogeneic blood transfusion group (group ABT).Both groups received epidural anesthesia.The radial artery was cannulated after epidural anesthesia,and the autologous blood was collected in group HAT.The autologous blood transfusion timing:intraoperative blood loss was expected to exceed 20％ of blood volume.For the patients in whom intraoperative blood loss was not expected to exceed 20％ of blood volume,bleeding was stopped,and autologous blood was infused intravenously after peritoneum closure.The allogeneic blood transfusion timing:when hemoglobin ＜ 70 g/L,packed red blood cells 1-5 U were infused intravenously;when prothrombin time,or activated partial thromboplastin time ＞ 1.5 times of the normal value,the fresh frozen plasma 100-400 ml was infused intravenously;when platelet count＜50× 109/L,platelets 10-40 U were infused intravenously.When entering the operating room (T0),on 1st day after operation (T1),and on 5th day after operation (T2),blood samples were collected to detect the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ (using FACScan flow cytometer),and serum interleukin-2 (IL-2) and IL-6 concentrations (by enzyme-linked immunosorbent assay).CD4+/CD8+ ratio was calculated.Results Compared with the values at T0,the levels of CD3+ and CD4+,CD4+/CD8+ ratio,and serum IL-2 concentrations were significantly decreased,and the serum IL-6 concentrations were increased at T1,2 in group ABT,and at T1 in group HAT (P＜0.05).Compared with group ABT,the CD3+ and CD4+ levels,CD4+/CD8+ ratio and serum IL-6 concentrations were significantly increased at T1,and the serum IL-2 concentrations were increased at T1,2 in group HAT (P＜0.05).Conclusion Compared with allogeneic transfusion,hemodiluted autotransfusion has less inhibitory effect on cellular immune function in the patients undergoing cesarean section.