Sarah L. Haynes

Autologous versus allogeneic transfusion in aortic surgery: a multicenter randomized clinical trial.

ObjectiveTo evaluate the efficacy of acute normovolemic hemodilution (ANH) and intraoperative cell salvage (ICS) in blood-conservation strategies for infrarenal aortic surgery. Summary Background DataRecent concerns over the risks of transfusion-related infection have resulted in sharp rises in the cost of blood preparations. Autologous transfusion may be a safe alternative to allogeneic transfusion, which has been associated with immune modulation and postoperative infection. MethodsThis multicenter prospective randomized trial compared standard transfusion practice with autologous transfusion combining ANH with ICS in 145 patients undergoing elective aortic surgery. The primary outcome measures were the proportion of patients requiring allogeneic blood and the volume of allogeneic transfusion. The secondary outcome measures were the frequency of complications, including postoperative infection, and postoperative hospital stay. ResultsThe combination of ANH and ICS reduced the volume of allogeneic blood transfused from a median of two units to zero units. The proportion of patients transfused was 56% in allogeneic and 43% in autologous. There were no significant differences in complications or length of hospital stay. ConclusionsBoth ANH and ICS were safe and reduced the allogeneic blood requirement in patients undergoing elective infrarenal aortic surgery.

Acute normovolemic hemodilution in moderate blood loss surgery: a randomized controlled trial

BACKGROUND:  The risks associated with allogeneic blood transfusion are increasingly recognized. More blood is cross‐matched for moderate blood loss surgery than any other indication. The role of acute normovolemic hemodilution (ANH) as a blood transfusion strategy was evaluated in a prospective randomized controlled trial.

Cerebral and peripheral oxygen saturation during red cell transfusion

BACKGROUND Changes in regional hemoglobin oxygen saturation occur in response to blood transfusion and can be measured by near infrared spectroscopy. PATIENTS AND METHODS Cerebral (CsO2) and peripheral (PsO2) oxygen saturation were monitored with an INVOS 4100 near infrared spectroscopy oximeter in 29 patients undergoing 84 intraoperative blood transfusions during aortic or spinal surgery. Hemoglobin concentration was measured before and after transfusion. Mean arterial pressure, end tidal carbon dioxide tension, and arterial oxygen saturation were also monitored. RESULTS Mean arterial pressure, arterial oxygen saturation and end tidal carbon dioxide tension remained stable during transfusion, while CsO2 rose by a mean (95% CI) of 4.2 (3.2-5.2%; P = 0.001) and PsO2 rose by a mean (95% CI) of 1.6 (0.3-2.8%; P = 0.016). The rise in CsO2 correlated well with the rise in hemoglobin (r = 0.59, P < 0.001) and with the volume transfused (r = 0.58, P < 0.001). PsO2 correlated with the volume transfused (r = 0.35, P = 0.019) but not with hemoglobin concentration (r = 0.08, P = 0.47). CONCLUSIONS Near infrared spectroscopy detected significant rises in tissue oxygenation in response to blood transfusion, particularly in the cerebral cortex. CsO2 may be developed into a blood loss monitor if further research confirms our findings.

Cerebral and peripheral near-infrared spectroscopy: an alternative transfusion trigger?

Background and Objectives To develop a transfusion trigger based on tissue oxygenation, near‐infrared spectroscopy (NIRS) was evaluated in a model of compensated haemorrhage.

Unchanging attitudes to autologous transfusion in the UK

. Our aim was to assess changes in attitudes to autologous transfusion amongst surgeons over a 10‐year period in response to scientific evidence, public awareness, published guidelines, management and the increasing cost of blood products.

Does washing swabs increase the efficiency of red cell recovery by cell salvage in aortic surgery

Background and Objectives  We investigated the contribution of swab washing to the efficiency of red cell recovery by intraoperative cell salvage (ICS) in 10 patients undergoing elective aortic aneurysm repair.

Cerebral Oxygen Saturation Measurements in Red Cell Transfusion

Anaemia is associated with decreased tissue oxygenation. It has been hypothesised that a fall in the oxygen extraction ratio (OER) following red cell transfusion demonstrates the appropriateness of the transfusion. If the red cell transfusion was necessary, then the OER would decrease post-transfusion, and this would be associated with an increase in cerebral oxygen saturation. If, however, transfusion was not needed then there would be no fall in OER post-transfusion. In this study, our objective was to compare non-invasive measurement of saturation with the invasive method of oxygen extraction determination. Thus, this is a test of the accuracy of the decision to transfuse.

Post-operative red cell salvage in total knee replacement

Abstract Post-operative cell salvage (PCS) reduces homologous blood use after knee replacement but liberal indication for transfusion in previous studies resulted in high homologous transfusion requirements. We evaluated PCS in patients undergoing knee replacement using a restrictive transfusion trigger (Hb n =20) or with standard wound drains ( n =20). Blood losses and transfusion requirements were recorded prospectively. Mean (SD) post-operative blood loss with PCS was 656 (317)ml, of which 433 (197)ml were re-infused. Control blood loss was comparable at 591 (328)ml. Blood transfusion was given to only one PCS patient; 2U, and five controls who received a total of 12U of homologous blood. Homologous transfusion was not necessary for most patients undergoing knee replacement when the indication for transfusion was restricted. PCS further decreased homologous blood requirements.