From the Guidelines
Intraoperative blood salvage for autologous transfusion does not require unit agitation to preserve platelet function, as the process of cell salvage itself involves washing and centrifugation of red cells, which inherently separates and preserves the blood components. The guidelines provided by the Association of Anaesthetists in 2018 1 outline the principles and practice of intra-operative cell salvage, emphasizing the use of anticoagulants and centrifugation to separate red cells from whole blood, but do not specifically mention the need for unit agitation to preserve platelet function.
Key Points to Consider
- The cell salvage process involves mixing shed blood with an anticoagulant, centrifugation to separate red cells, and washing with saline before reinfusion 1.
- The use of anticoagulants such as heparin or acid-citrate dextrose is crucial in preventing clotting during the collection and processing of blood for autologous transfusion 1.
- While platelet function preservation is important, the primary focus of cell salvage is on the recovery and reinfusion of red blood cells to reduce the need for allogeneic transfusions and manage postoperative anemia 1.
- The guidelines recommend considering cell salvage in cases where blood loss is expected to exceed 500 ml in adult patients, among other scenarios, but do not specify requirements for unit agitation 1.
Clinical Implications
The decision to use cell salvage should be based on the expected blood loss, patient risk factors for bleeding, and the potential benefits of reducing allogeneic transfusions 1. Given the information provided, the process of cell salvage as described does not inherently require unit agitation for the preservation of platelet function, as the washing and centrifugation steps are designed to preserve the integrity of the blood components. However, it is essential to follow established guidelines and consider the specific clinical context when making decisions about intraoperative blood salvage for autologous transfusion.
From the Research
Intraoperative Blood Salvage for Autologous Transfusion
- The provided studies do not directly address the requirement of unit agitation to preserve platelet function in intraoperative blood salvage for autologous transfusion 2, 3, 4, 5, 6.
- However, the studies discuss various aspects of intraoperative blood salvage and autologous transfusion, including the use of autotransfusion devices, cell saver techniques, and autologous plateletpheresis 2, 4, 5.
- The study by 5 mentions the use of an automated plateletpheresis device to collect autologous platelets, but does not specifically address the issue of unit agitation.
- Another study 6 discusses the use of intraoperative hemodilution and autologous platelet rich plasma collection, but also does not mention unit agitation.
- Overall, there is no direct evidence in the provided studies to support or refute the requirement of unit agitation to preserve platelet function in intraoperative blood salvage for autologous transfusion.
Autologous Transfusion Techniques
- Intraoperative autologous transfusions have been used for many years to avoid transmission of infections, especially in vascular surgery 4.
- Autologous plateletpheresis collection programs have been established to reduce the use of allogeneic platelets 5.
- Intraoperative hemodilution and autologous platelet rich plasma collection are two techniques used to obtain autologous blood in the operating room 6.
- These techniques have the advantage of providing fresh blood not subject to the storage lesion 6.
Blood Conservation Strategies
- Intraoperative blood salvage is only one part of an effective program to minimize homologous transfusion 2.
- Other strategies include the use of preoperatively donated blood, effective and safe pharmacological agents to enhance haemostasis and haematopoiesis, and a conservative approach to transfusion 2.
- Point-of-care autologous blood procurement can replace the predonation of autologous blood in surgical patients when transfusion medicine specialists, anesthesiologists, and surgeons develop a prospective, comprehensive approach to blood conservation 3.