QUALITY ASSESSMENT OF INTRAOPERATIVE BLOOD SALVAGE AND AUTOTRANSFUSION

Intraoperative blood salvage and autotransfusion are commonly used to minimize exposure to banked blood. Although this technique has been us ed widely for years, data vary regarding the quality of autotransfused blood. Salvaged blood may contain plasma, residual heparin, and free hemoglobin released from damaged cells. All of these factors may contr ibute to the adverse sequelae sometimes seen with autotransfusion. For these reasons, we have monitored autotransfused blood to assess its q uality. Intraoperative blood salvage was used during most cardiac proc edures and at the discretion of the surgeon in other specialties. Bloo d was collected through a double lumen catheter that was anticoagulate d with heparin, filtered, centrifuged, and washed with saline. A sampl e of the blood was removed for analysis, which included hematocrit, he parin assay, fibrinogen, and free hemoglobin levels. Over a 6-year per iod, 1593 patients had intraoperative blood salvage with quality asses sment. The majority of patients underwent cardiac operations (941 pati ents, 59%), whereas 243 had orthopedic (15%) and 208 had vascular (13% ) procedures. Additionally, there were 127 pediatric patients (8%) and 74 miscellaneous procedures (5%). The highest average yield of salvag ed blood was during vascular procedures (1073 +/- 76 mL), whereas orth opedic cases had the lowest yield (378 +/- 19 mi) and hematocrit (39%) . There was minimal residual heparin activity, even in patients requir ing systemic anticoagulation (0.3 to 0.5 units/mL). Patients undergoin g pediatric procedures had the lowest concentration of free hemoglobin (476 mg/L), whereas all adult patients had higher free hemoglobin lev els, especially vascular operations (990 mg/L). Intraoperative salvage d blood has minimal heparin activity, even in procedures requiring sys temic anticoagulation. Fibrinogen, a marker of residual plasma, was un detectable in the majority of cases. These data indicate that intraope rative blood salvage generally results in a high-quality product (good hematocrit, low heparin, minimal plasma), although there are signific ant differences in free hemoglobin levels depending on the operative p rocedure.