Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion

AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage.

The impact of intra-operative cell salvage during open nephrectomy

Objective:To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy.Methods:A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017.Patients were grouped and compared based on whether they received intra-operative cell salvage(ICS).Primary outcomes were allogeneic transfusion rates(ATRs),and if histology confirmed cancer,disease recurrence.Secondary outcomes were complications and transfusion-related cost.Results:Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period.Sixteen patients received ICS while 24 did not(standard group).Compared with the standard group,ICS patients had similar median age(63.5 vs.61.0 years;p=0.83)but fewer females(19%vs.58%;p=0.013).The groups were similar in pre-operative and discharge haemoglobin,Charlson Comorbidity Index,length of hospital stay and proportion with thoracoabdominal surgical approach.The ICS group had a smaller proportion undergoing partial nephrectomy(19%vs.54%;p=0.025)and shorter median follow-up(278 vs.827 days;p=0.0005).Histology was malignant for 14 ICS and 15 standard patients.The ICS group had more frequent
T2 disease(79%vs.27%;p=0.005).There were no positive margins.Both groups had similar ATRs(6%vs.4%;p=0.96),complication rates(19%vs.29%;p=0.46)and recurrence rates(18%vs.7%;p=0.40).Transfusion costs were higher amongst ICS patients(AUD$878.18 vs.$49.65 per patient).Conclusion:ICS appears safe,with low rates of recurrence and complication.Both groups had low ATRs,and therefore cost benefit for ICS was not seen.

Effect of intraoperative cell rescue on bleeding related indexes after cesarean section

BACKGROUND Obstetric hemorrhage is the leading cause of maternal mortality globally,especially in China.The key to a successful rescue is immediate and rapid blood transfusion.Autotransfusion has become an integral part of clinical blood transfusion,with intraoperative cell salvage(IOCS)being the most widely used.AIM To investigate the application of IOCS in cesarean section.METHODS A total of 87 patients who underwent cesarean section and blood transfusion in our hospital from March 2015 to June 2020 were included in this prospective controlled study.They were divided into the observation(43 cases)and control(44 cases)groups using the random number table method.The patients in both groups underwent lower-segment cesarean section.The patients in the control group were treated with traditional allogeneic blood transfusion,whereas those in the observation group were treated with IOCS.Hemorheology[Red blood cell count,platelet volume,and fibrinogen(FIB)]and coagulation function(partial prothrombin time,prothrombin time(PT),platelet count,and activated coagulation time)were measured before and 24 h after transfusion.In the two groups,adverse reactions,such as choking and dyspnea,within 2 h after cesarean section were observed.RESULTS Before and after transfusion,no significant differences in hemorheology and coagulation function indices between the two groups were observed(P>0.05).About 24 h after transfusion,the erythrocyte count,platelet ratio,and FIB value significantly decreased in the two groups(P<0.05);the PLT value significantly decreased in the two groups;the activated partial thromboplastin time,PT,and activated clotting time significantly increased in the two groups(P<0.05);and no statistical differences were observed in hemorheology and coagulation function indices between the two groups(P>0.05).Furthermore,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION In patients undergoing cesarean section,intraoperative cell salvage has a minimum effect on hemorheology and coagulation function and does not increase the risk of amniotic fluid embolism.

Transfusion and coagulation management in liver transplantation

There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently. Allogenic blood products have been shown to increase morbidity and mortality. Primary haemostasis, coagulation and fibrinolysis are altered by liver disease. This, combined with intraoperative disturbances of coagulation, increases the risk of bleeding. Meanwhile, the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis. The application of the principles of patient blood management to transplantation can reduce the risk of transfusion. This includes: preoperative recognition and treatment of anaemia, reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers. The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management. Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis, and rarely, the use of recombinant factor VIIa. Factor concentrates are increasingly used; fibrinogen concentrates to improve clot strength and stability, and prothrombin complex concentrates to improve thrombin generation. Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure. The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion. Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation.