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Intraoperative Cell Saving: Is the Solution the Actual Problem?
Krishnan Pillay1, Shobashini Perumal1
1Department of Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa; Department of Cardiovascular Perfusion, Division of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
Washing residual cardiopulmonary bypass blood with Balsol solution, a bicarbonate-buffered fluid, yields a superior red blood cell concentrate compared to normal saline. This method improves electrolyte profiles and maintains a balanced strong ion difference for autologous blood recovery.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Biochemistry
Background:
- Allogenic blood is a limited resource, necessitating strategies to maximize autologous blood availability.
- Residual blood in cardiopulmonary bypass circuits presents an opportunity for autologous recovery using cell salvage.
- Current cell salvage protocols often use normal saline (NS), prompting investigation into alternative washing solutions.
Purpose of the Study:
- To quantitatively compare the quality of residual cardiopulmonary bypass blood washed with normal saline (NS) versus a bicarbonate-buffered solution (Balsol).
- To assess the impact of different washing solutions on key biochemical parameters of salvaged autologous blood.
Main Methods:
- An in vitro analysis was performed on residual blood from forty cardiopulmonary bypass circuits.
- Blood was processed using a cell saver device, washed with either NS or Balsol solution.
- Measurements included pH, electrolytes, metabolites, hematocrit, hemoglobin, osmolality, albumin, total protein, and strong ion difference.
Main Results:
- Significant differences were observed between the NS and Balsol washing groups.
- The Balsol group demonstrated osmolality, electrolyte, and strong ion difference values closer to the Balsol solution itself post-washing.
- The NS group did not achieve similar electrolyte or strong ion difference profiles.
Conclusions:
- Washing residual cardiopulmonary bypass pump blood with Balsol solution produces a resuspended red blood cell concentrate with a superior electrolyte profile.
- Balsol solution washing results in a strong ion difference comparable to that of the original residual pump blood, unlike NS washing.
