Paul S. Potter

Amniotic Fluid Removal during Cell Salvage in the Cesarean Section Patient

Background Cell salvage has been used in obstetrics to a limited degree because of a fear of amniotic fluid embolism. In this study, cell salvage was combined with blood filtration using a leukocyte depletion filter. A comparison of this washed, filtered product was then made with maternal central venous blood. Methods The squamous cell concentration, lamellar body count, quantitative bacterial colonization, potassium level, and fetal hemoglobin concentration were measured in four sequential blood samples collected from 15 women undergoing elective cesarean section. The blood samples collected included (1) unwashed blood from the surgical field (prewash), (2) washed blood (postwash), (3) washed and filtered blood (postfiltration), and (4) maternal central venous blood drawn from a femoral catheter at the time of placental separation. Results Significant reductions in the following parameters were seen when the postfiltration samples were compared to the prewash samples (median [25th–75th percentile]): squamous cell concentration (0.0 [0.0–0.1 counts/high-powered field (HPF)] vs. 8.3 counts/HPF [4.0–10.5 counts/HPF], , P < 0.05); bacterial contamination (0.1 [0.0–0.2]vs. 3.0 [0.6–7.7] colony-forming units (CFU)/ml, P < 0.01); and lamellar body concentration (0.0 [0.0–1.0]vs. 22.0 [18.5–29.5] thousands/&mgr;l, P < 0.01). No significant differences existed between the postfiltration and maternal samples for each of these parameters. Fetal hemoglobin was in higher concentrations in the postfiltration sample when compared with maternal blood (1.9 [1.1–2.5]vs. 0.5% [0.3–0.7] ). Potassium levels were significantly less in the postfiltration sample when compared with maternal (1.4 [1.0–1.5]vs. 3.8 mEq/l [3.7–4.0]). Conclusions Leukocyte depletion filtering of cell-salvaged blood obtained from cesarean section significantly reduces particulate contaminants to a concentration equivalent to maternal venous blood.

Preoperative Autologous Donation Versus Cell Salvage in the Avoidance of Allogeneic Transfusion in Patients Undergoing Radical Retropubic Prostatectomy

There are many methods for preventing allogeneic blood administration during radical retropubic prostatectomy, and many of these methods have been compared with each other, but no studies have compared preoperative autologous donation (PAD) and cell salvage (CS). In this study, we evaluated these two methods in patients undergoing radical retropubic prostatectomy. In a prospective cohort model, allogeneic exposure in patients from one surgeon who routinely had his patients donate blood before surgery was compared with that in patients from a different surgeon who predominantly used CS. Fifty patients were enrolled in the study: 26 in the PAD group and 24 in the CS group. No difference in allogeneic exposure was seen between the two groups. A significant difference was seen in the volume of red blood cells lost (891 ± 298 mL versus 1134 ± 358 mL in the PAD and CS groups, respectively). We conclude that PAD and CS are equivalent in their ability to avoid allogeneic transfusion. Larger surgical blood loss in the CS group would suggest that in a more rigorously designed study, CS might provide better allogeneic avoidance than PAD.