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Intraoperative Autologous Transfusion of Hemolyzed Blood Anesth Analg 2009; July, 109:38 – 42

Intraoperative Autologous Transfusion of Hemolyzed Blood Anesth Analg 2009; July, 109:38 – 42. 北京天坛医院麻醉科 赵岩.

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Intraoperative Autologous Transfusion of Hemolyzed Blood Anesth Analg 2009; July, 109:38 – 42

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  1. Intraoperative Autologous Transfusion ofHemolyzed BloodAnesth Analg 2009; July, 109:38 –42 北京天坛医院麻醉科 赵岩

  2. Although a large number of studies demonstrate the value of IBS in cardiac and vascular surgery, the process is not without risk and may not be advantageous for all orthopedic procedures.

  3. Potential complications properly functioning IAT device experienced machine operator scoliosis and hardware placement hemoglobinuria coagulopathy

  4. Case 1--- 55-yr-old woman Within 5–10 min 34 min after transfusion 3.5 h after induction a brief episode of hypertension(200/120mmHg) bradycardia 200 mL IBS unit hemoglobinuria Fhb 96 mg/dL Abnormal TEG bleeding hemostatic wound edges and needle puncture sites. residual from the first unit revealed gross hemolysis 200 mg calcium chloride 2 U of PRBC 2 U of FFP sodium bicarbonate Furosemide fluids

  5. Case 2--- 46-yr-old man 4.5h after incision Blood loss 400ml/h 600-1200ml/h 300 mL IBS unit hemoglobinuria Abnormal TEG PT=16.9s, INR=1.4 4500 mL IBS blood 683 mL FFP 2 U of PRBC 251 mL platelets (8 U) an estimated 6900 mL blood loss 1g Cacl2 Crystalloids furosemide mannitol

  6. hemoglobinuria

  7. Coagulation results-TEG

  8. Coagulation profiles DIC DDimer= 9640 D-二聚体是纤维蛋白单体经活化凝血因子交联后再经纤溶酶水解所产生的一种降解产物，它是交联纤维蛋白形成和纤溶酶被激活的标志。其血浆浓度升高反映了体内有血栓形成或高凝状态，可作为体内高凝状态和继发性纤溶亢进的分子标志物之一

  9. DISCUSSION • In one study of 56 patients, the use of IAT was associated with a higher incidence of • respiratory complications (40% vs 12.5%) • greater transfusion of blood (5.8 vs 3.6 U) • FFP (4.4 vs 1.5 U) • a longer hospital stay (9.3 vs 5.6 days)

  10. DISCUSSION Bone chips Smaller diameter Suction device hemolysis More mechannical trauma skim Higher suction pressure Spine surgery 与钾离子不同，游离血红蛋白及红细胞碎片由于密度的原因 可能经过离心清洗后仍有部分残留于回收红细胞悬液中

  11. DISCUSSION • Free Hb in the collection reservoir ranged between 49.9 and 4689.9 mg/L (mean of 651mg/L), demonstrating hemolysis with the collection process. • The free Hb in the washed processed cells was between198.2 and 2645 mg/L (mean of 705 mg/L) demonstrating that the centrifugal processing and washing does not remove all stroma-free hemoglobin.

  12. DISCUSSION FHb NO BP Pulmonary circulation thrombus formation platelet activation inflammatory substances

  13. DISCUSSION • The coagulation process can also be initiated by cytokine and complement released from damaged RBCs and leukocytes. • DIC can also be induced by the reinfusion of thrombin or Gelfoam collected from the wound by IBS.

  14. DISCUSSION • These cases suggest IBS should be evaluated for its risk-benefit in individual cases. • Studies are necessary to determine ways to reduce hemolysis and cellular damage during the collection process or IBS processing to reduce these potential complications in instrumented spine surgery.

  15. thank you 感谢梁辉同志的大力支持

  16. TEG:通过测量血凝块物理特性来反映凝血因子和血小板数目功能以及纤维蛋白原水平，是一个以整个动态过程来监测凝血与纤溶功能的重要指标．TEG:通过测量血凝块物理特性来反映凝血因子和血小板数目功能以及纤维蛋白原水平，是一个以整个动态过程来监测凝血与纤溶功能的重要指标．

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