J. Umlas

Red cell loss following orthopedic surgery: the case against postoperative blood salvage.

BACKGROUND: Expensive devices have been developed for the collection and transfusion of blood salvaged after hip or knee arthroplasty.

Fibrinolysis and Disseminated Intravascular Coagulation in Open Heart Surgery

Fibrinolysis and disseminated intravascular coagulation (DIC) have been implicated as the cause or contributing mechanisms for hemorrhage during and after cardiopulmonary bypass. Even when unassociated with hemorrhage, both processes have been thought to be common occurences during open heart surgery. In order to measure the degree to which these mechanisms occur, fibrin split products (FSP) were measured simultaneously in blood and chest tube drainage of open heart surgical patients. In addition, serial measurements of platelets and fibrinogen were also measured in the blood of these patients. It is concluded that fibrinolysis invariably occurs to a high degree in the chest postoperatively but with few systemic manifestations and that fibrinolysis and/or DIC are rare causes of a hemorrhagic diathesis after cardiopulmonary bypass.

The cost‐effectiveness of postoperative recovery of RBCs in preventing transfusion‐associated virus transmission after joint arthroplasty

BACKGROUND: The return of joint drainage after hip and knee arthroplasty is a widely used but expensive blood‐conservation technique.

Survival and half-life of red cells salvaged after hip and knee replacement surgery

The survival of autologous red cells collected intraoperatively has been reported previously. This study measures the survival and half‐ life of red cells collected 3 hours after hip and knee arthroplasty. For six patients, four having knee replacements and two having hip replacements, the salvaged red cells were labeled with radioactive 51Cr. Peripheral blood was simultaneously labeled with nonradioactive 52Cr. There was no significant difference in the survival or half‐life of the salvaged and the venous blood.

Suitable survival and half‐life of red cells after frozen storage in excess of 10 years

To examine the appropriateness of the Food and Drug Administrations 10‐year storage time for previously frozen red cells, 24‐hour posttransfusion survival studies were performed, and the half‐life of 3 units of autologous red cells that had been stored for 13.5, 14, and 17 years, respectively, was measured. The units had acceptable freeze‐thaw‐ wash recovery (83.3–91.4%). When a 51Cr label was used for the previously frozen red cells and a simultaneous 52Cr label for freshly drawn autologous red cells was used as a comparison, it was seen that the previously frozen cells had normal 24‐hour posttransfusion survival (75.1–88.4%) as well as normal half‐life (23–33.7 days). These findings support further extension of the maximum allowable storage time for previously frozen red cells.

Washed hyperpacked frozen and shelf red blood cells.

In order to determine the maximum degree to which blood units could be packed and still be effective, shelf stored blood and previously frozen red blood cells were washed and hyperpacked to hematocrits of 90 to 98 per cent. These products had average volumes of 180 and 162 ml, respectively. When transfused into a group of patients with stable nonhemolytic anemias or with slow or intermittent blood loss, the hyperpacked shelf stored blood resulted in average hematocrit increments of 4.4 per cent; the hyperpacked frozen red blood cells resulted in average hematocrit increments of 3.4 per cent. Conventionally packed unwashed red blood cells had approximately 10 per cent more hemoglobin and volumes of 270 to 330 ml, but resulted in average hematocrit elevations of only 2.8 per cent. Unwashed blood hyperpacked to hematocrits of 90 per cent with removal of the visible buffy coat took much longer to administer. Thus, by washing and hyperpacking shelf stored blood or previously frozen red blood cells, transfusions with the minimal amount of extraneous material can be given.