Data published in the Archives of Surgery suggest that during trauma surgery, reinfusing a patient’s own shed blood—in addition to donor transfusions—is a safe, effective, and cost-saving alternative to donor (allogeneic) transfusions alone. However, the study was small and the procedure is likely to require additional resources above and beyond those currently available in smaller facilities. 

Extensive blood loss plays a significant role in patient mortality during emergency trauma surgery, and often requires donor transfusions of packed red blood cells and plasma. However, donor transfusion is associated with a number of complications and transfusion reactions. Therefore, a team of Texas-based surgeons designed a retrospective matched cohort study to evaluate whether cell salvage (CS), the process of collecting, cleaning, and reinfusing a patient’s shed blood, could be a clinical and cost-effective adjunct to donor transfusion. 

Forty-seven patients who had undergone urgent laparotomy, thoracic, or orthopedic surgery and received CS were matched with a non-CS group (n=47) for age, sex, and surgery performed as well as severity and mechanism of the injury. The autologous blood supply was generated from shed blood that was vacuumed from the surgical field, mixed with heparin, and pumped to a sterile container for reinfusion. 

Patients who received CS required fewer intraoperative (2 versus 4) and total units (4 versus 8) of allogeneic packed red blood cells than the donor group; the CS group also received fewer total units of plasma (3 versus 5). There was no significant difference in length of time spent in the intensive care unit or in the hospital, nor was there any significant difference in mortality between the two groups. The total cost of blood transfusion per patient was $1616 in the CS group compared with $2584 in the donor group (P=0.04). 

The authors cite several obstacles to implementing this procedure among hospitals that do not routinely use CS transfusion, including issues related to blood contamination and coagulopathy. They also call for additional studies to confirm the safety of transfusing contaminated blood, as well as to preoperatively identify patients who would most benefit from the technique.

1. Brown CV, Foulkrod KH, Sadler HT, et al. Autologous blood transfusion during emergency trauma operations. Arch Surg. 2010;145(7):690-694. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/20644133Accessed August 23, 2010.

Posted in News Service
This entry was posted on Monday, August 23rd, 2010 at 12:00 pm.