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Autologous Blood Transfusion

WHEN CAN CELL SALVAGE HELP?

1998 health circular regarding better blood transfusion advised a more rational use to blood transfusion. The recommendation advised that a Hospital Transfusion Committee be set up in all hospitals to monitor blood usage.

This recommendation was made for two reasons. The first is the mounting evidence that preoperative blood transfusion can alter the immune response of the recipient. This appears to be a homologous leucocyte effect, although there remains some debate about this. The decision by the risk analysis group to advise that all UK blood products be leucoreduced to decrease new variant CJD transmission has, reduced the immunomodulation effect , but added to production cost of blood products . A suggestion to monitor and rationalise blood use would therefore decrease costs and eliminate the risk to our patients of blood transmitted infections as yet unidentified.

The annual number of Total Knee replacements (TKR) and Total Hip Replacements (THR) has increased. The majority of orthopaedic patients who have received cell salvage have been patients undergoing TKR with a mean salvage of 1.5 units following washing and resuspension of post-operative wound drainage. All salvaged blood is post tourniquet release in these patients and collection is usually continued on the ward for up to 6 hours post-operatively.

Total hip replacement patients are selected for cell salvage if they are revisions or cementless procedures. The mean salvaged in these patients is 2.5 units.

In some open fractures it is possible to collect the blood in appropriately placed drapes allowing a degree of blood pooling. 



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