Abstract
Aortic aneurysm resection is frequently associated with considerable blood loss and requires transfusion. To minimize complications and cost many institutions use a “cell saving” method that allows reinfusion of the washed red cell fraction of blood suctioned from the operative field. The disadvantages of this technique are that homologous transfusion is regularly required to replace platelets and coagulation factors. Red cell transfusion may also be required when there is rapid major blood loss as the wash cycle may be too long to subject a patient, in a high-risk group for coronary artery disease, to anaemia. A new autoinfusion device anticoagulates blood as it is suctioned from the operative field then filters, defoams, and returns it whole to the patient without a processing time lapse. We successfully used the device in a patient for aortic aneurysm resection to reinfuse two-thirds of his blood volume shed over 80 min. Neither banked red cells nor plasma were used. His haematocrit and coagulation profile remained stable throughout surgery and recovery. The potential complications and cost of homologous transfusion were avoided.
Résumé
La résection d’un anévrysme aortique est souvent associée à des pertes sanguines considérables et à l’administration de transfusions. Pour minimiser les complications et les coûts, plusieurs institutions utilisent des récupérateutrs de cellules (cell savers) qui permettent la reperfusion des cellules lavées aspirées du site chirurgical. Par contre, cette technique a ses désavantages car il faut quelquefois avoir recours à des transfusions de sang homologue pour remplacer les plaquettes et les facteurs de coagulation. Des transfusions peuvent aussi être nécessitées par une perte rapide de sang qui dépasse en vitesse les cycles du lavage chez les coronariens qui supportent mal l’anémie. Un nouvel appareil d’autotransfusion anticoagule le sang à mesure qu’il est aspiré, le filtre, le démousse et le retourne au patient sans délai. Nous avons utilisé avec succès cet appareil sur un patient pour lui retransfuser les deux tiers de son volume sanguin perdu en 80 minutes. On n’a pas utilisé de sang conservé, ni de plasma. Lhématocrite et le coagulogramme sont demeurés stables pendant la chirurgie et à la phase de réveil. On a peut-être ainsi évité les complications et le coût reliés aux transfusions de sang homologue.
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Garry, B., Lisman, S. & Wurm, W.H. Intraoperative reinfusion of whole blood using a new autoinfusion device. Can J Anaesth 40, 791–795 (1993). https://doi.org/10.1007/BF03009776
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DOI: https://doi.org/10.1007/BF03009776