Cell Saver, Ultrafiltration and Direct Transfusion:
Comparative Study of Three Blood Processing Techniques

Background: Intraoperative blood salvage is an important part of blood conservation efforts in cardiac surgery. The purpose of this study is to examine the effects of three different circuit blood-salvaging techniques: centrifugation, ultrafiltration and direct infusion. Methods: Sixty patients undergoing elective coronary bypass graft procedures were randomly assigned in a prospective manner to one of the three blood-salvaging methods. Results: Intra- and postoperative blood samples demonstrated increased hemoglobin values in the direct infusion group and higher platelet count in the ultrafiltration group. There were no significant differences in these results. The analysis of coagulation parameters revealed a similar prolongation of partial thromboplastin time and activated clotting time in all groups. The amount of blood loss was not significantly different between the three blood conservation methods. The effect of direct infusion method does not result in either major disturbance of coagulation parameters or in increased blood loss. Conclusion: In a sample of adult patients undergoing coronary artery bypass grafting, direct transfusion is, in consideration of the cost-effective factor, an appropriate approach for returning cardiopulmonary bypass circuit blood.

Cardiac surgery - Cell saver - Ultrafiltration - Direct transfusion - Blood-salvaging

References

• 1 Kochamba G S, Pfeffer T A, Sintek C F, Khonsari S. Intraoperative autotransfusion reduces blood loss after cardiopulmonary bypass.  Ann Thorac Surg. 1996;  61 (3) 900-903
• 2 McCarthy P M, Popovsky M A, Schaff H V. et al .Effect of blood conservation efforts in cardiac operations at the Mayo Clinic. 1998 63: 225-229
• 3 Krieger K H, Isom O W,. et al .Blood conservation in cardiac surgery. 1983 13: 355-368
• 4 Solem J O, Tengborn L, Steen S. et al . Cell Saver versus hemofiltrator for concentration of oxygenator blood after cardiopulmonary bypass.  Thorac Cardiovasc Surg. 1987;  35 42-47
• 5 Boldt J, Kling D, von Bormann B. et al . Blood conservation in cardiac operations-cell separation versus hemofiltration.  J Thorac Cardiovasc Surg. 1989;  97 832-840
• 6 Nakamura Y, Masuda M, Toshima Y. et al . Comparatice study of Cell Saver and ultrafiltration nontransfusion in cardiac surgery.  Ann Thorac Surg. 1990;  49 973-978
• 7 Sutton R G, Kratz J M, Spinale F G. et al . Comparison of three blood processing techniques during and after cardiopulmonary bypass.  Ann Thorac Surg. 1993;  56 938-943
• 8 Zhou J L, Guan H P. Ultrafiltration and two-hemodilution during excessive hemodilution cardiopulmonary bypass.  Chin Med J. 1988;  101 807-810
• 9 Johnson H D, Morgan M S, Utley J R. et al . Comparative analysis of recovery of cardiopulmonary bypass residual blood: Cell Saver vs Hemoconcentrator.  J Extracorp Tech. 1994;  26 (4) 195-199
• 10 Williams G D, Ramamoorthy C, Totzek F R, Oakes R L. Comparison of the effects of red cell separation and ultrafiltration on heparin concentration during pediatric cardiac surgery.  J Cardiothorac Vasc Anesth. 1997;  11 (7) 840-844
• 11 Boldt J, Zickmann B, Fedderson B, Herold C, Dapper F. Six different hemofiltration devices for blood conservation in cardiac surgery.  Ann Thorac Surg. 1991;  51 (5) 747-753