Skip to main content

Advertisement

SpringerLink
Log in

Acute Kidney Injury Secondary to Cell Saver in Posterior Spinal Fusion

  • Case Reports
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Background

Autologous blood transfusion, commonly referred to as cell saver, is frequently used in spinal fusion to salvage red blood cells because of the risk of significant intraoperative blood loss. This case report describes a case of acute kidney injury (AKI) secondary to cell saver use. Our objective is to increase the knowledge about the process of red blood cell salvage and this exceedingly rare complication.

Methods

Chart and renal biopsy results for a single case were reviewed and reported in this retrospective study.

Results

A healthy 18-year-old male patient underwent posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis with utilization of intraoperative autologous blood transfusion. The patient subsequently developed hematuria and AKI with a peak creatinine of 13.9 mg/dL. An extensive clinical workup, including autoimmune serology, excluded any identifying causes. A renal biopsy showed pigment-induced acute tubular necrosis.

Conclusions

This case, to our knowledge, is the first and only case report of AKI secondary to cell saver demonstrated by renal biopsy. The literature has shown both the benefit of cell saver by decreasing the need for allogeneic transfusion and the risk of transient hematuria. However, this case demonstrates the importance of monitoring patients for potential complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Feltracco P, Brezzi M, Barbieri S, et al. Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation. World J Hepatol 2013;5:1–15.

    Article  Google Scholar 

  2. Yu X, Xiao H, Wang R, et al. Prediction of massive blood loss in scoliosis surgery from preoperative variables. Spine (Phila Pa 1976) 2013;38:350–5.

    Article  Google Scholar 

  3. Thompson M, Kohring J, McFann K, et al. Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion. Spine J 2014;14:1392–8.

    Article  Google Scholar 

  4. Chanda A, Smith D, Nanda A. Autotransfusion by cell saver technique in surgery of lumbar and thoracic spinal fusion with instrumentation. J Neurosurg 2002;96:298–303.

    Google Scholar 

  5. Burman JF, Westlake AS, Davidson SJ, et al. Study of five cell salvage machines in coronary artery surgery. Transfus Med 2002;12:173–9.

    Article  CAS  Google Scholar 

  6. Sloan T, Myers G, Janik D, et al. Intraoperative autologous transfusion of hemolyzed blood. Anesth Analg 2009;109:38–42.

    Article  Google Scholar 

  7. Henn A, Hoffmann R, Müller HA. Haptoglobin determination in the serum of patients following intraoperative autotransfusion using the Haemonetics Cell Saver III. Studies on the loading of patients with free hemoglobin in retransfused erythrocyte concentrate [in German]. Anaesthesist 1988;37:741–5.

    CAS  PubMed  Google Scholar 

  8. Ashworth A, Klein A. Cell salvage as part of a blood conservation strategy in anaesthesia. Br J Anaesth 2010;105:401–16.

    Article  CAS  Google Scholar 

  9. Bowen R, Gardner S, Scaduto A, et al. Efficacy of intraoperative cell salvage systems in pediatric idiopathic scoliosis patients undergoing posterior spinal fusion with segmental spinal instrumentation. Spine (Phila Pa 1976) 2010;35:246–51.

    Article  Google Scholar 

  10. Goulet J, Bray T, Timmerman L, et al. Intraoperative autologous transfusion in orthopaedic patients. J Bone Joint Surg Am 1989;71:3–8.

    Article  CAS  Google Scholar 

  11. Hill G, Frawley W, Griffith K, et al. Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma 2003;54:908–14.

    Article  Google Scholar 

  12. Huët C, Salmi L, Fergusson D, et al. A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery. International Study of Perioperative Transfusion (ISPOT) Investigators. Anesth Analg 1999;89:861–9.

    Article  Google Scholar 

  13. McMurray M, Birnbaum M, Walter N. Intraoperative autologous transfusion in primary and revision total hip arthroplasty. J Arthroplasty 1990;5:61–5.

    Article  CAS  Google Scholar 

  14. Liang J, Shen J, Chua S, et al. Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study. Eur Spine J 2015;24:270–5.

    Article  Google Scholar 

  15. Heiss M, Mempel W, Jauch K, et al. Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery. Lancet 1993;342:1328–33.

    Article  CAS  Google Scholar 

  16. Carless P, Henry D, Moxey A, et al. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2010:CD001888.

  17. Ersen O, Ekıncı S, Bılgıc S, et al. Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system: a retrospective comparison. Musculoskelet Surg 2012;96:107–10.

    Article  Google Scholar 

  18. Landers D, Hill G, Wong K, et al. Blood transfusion-induced immunomodulation. Anesth Analg 1996;82:187–204.

    CAS  PubMed  Google Scholar 

  19. Kirkley SA. Proposed mechanisms of transfusion-induced immunomodulation. Clin Diagn Lab Immunol 1999;6:652–7.

    Article  CAS  Google Scholar 

  20. Blumberg N, Heal J. Transfusion and recipient immune function. Arch Pathol Lab Med 1989;113:246–53.

    CAS  PubMed  Google Scholar 

  21. Owens R, Crawford C, Djurasovic M, et al. Predictive factors for the use of autologous cell saver transfusion in lumbar spinal surgery. Spine (Phila Pa 1976) 2013;38:E217–22.

    Article  Google Scholar 

  22. Weiss JM, Skaggs D, Tanner J, Tolo V. Cell Saver: is it beneficial in scoliosis surgery? J Child Orthop 2007;1:221–7.

    Article  Google Scholar 

  23. Elgafy H, Bransford R, McGuire R, et al. Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery? Spine (Phila Pa 1976) 2010;35:S47–56.

    Article  Google Scholar 

  24. Canan C, Myers J, Owens R, et al. Blood salvage produces higher total blood product costs in single-level lumbar spine surgery. Spine (Phila Pa 1976) 2013;38:703–8.

    Article  Google Scholar 

  25. Gause P, Siska P, Westrick E, et al. Efficacy of intraoperative cell saver in decreasing postoperative blood transfusions in instrumented posterior lumbar fusion patients. Spine (Phila Pa 1976) 2008;33:571–5.

    Article  Google Scholar 

  26. Siller T, Dickson J, Erwin W. Efficacy and cost considerations of intraoperative autologous transfusion in spinal fusion for idiopathic scoliosis with predeposited blood. Spine (Phila Pa 1976) 1996;21:848–52.

    Article  CAS  Google Scholar 

  27. Reitman C, Watters W, Sassard W. The Cell Saver in adult lumbar fusion surgery: a cost-benefit outcomes study. Spine (Phila Pa 1976) 2004;29:1580–3.

    Article  Google Scholar 

  28. Solomon M, Rutledge M, Kane L, et al. Cost comparison of intraoperative autologous versus homologous transfusion. Transfusion 1988;28:379–82.

    Article  CAS  Google Scholar 

  29. Bull B, Bull M. The salvaged blood syndrome: a sequel to mechanochemical activation of platelets and leukocytes? Blood Cells 1990;16:5–20.

    CAS  PubMed  Google Scholar 

  30. Tawes Jr R, Duvall T. Is the “salvaged-cell syndrome” myth or reality? Am J Surg 1996;172:172–4.

    Article  Google Scholar 

  31. McKie J, Herzenberg J. Coagulopathy complicating intraoperative blood salvage in a patient who had idiopathic scoliosis. A case report. J Bone Joint Surg Am 1997;79:1391–4.

    Article  CAS  Google Scholar 

  32. Ramirez G, Romero A, García-Vallejo J, et al. Detection and removal of fat particles from postoperative salvaged blood in orthopedic surgery. Transfusion 2002;42:66–75.

    Article  Google Scholar 

  33. Keverline J, Sanders J. Hematuria associated with low-volume cell saver in pediatric orthopaedics. J Pediatr Orthop 1998;18:594–7.

    Article  CAS  Google Scholar 

  34. Halpern N, Alicea M, Seabrook B, et al. Cell saver autologous transfusion: metabolic consequences of washing blood with normal saline. J Trauma 1996;41:407–15.

    Article  CAS  Google Scholar 

  35. Vorweg M, Muckel G, Knüttgen D, et al. Heparin-induced coagulation disturbance from mechanical autotransfusion [in German]. Anaesthesist 1998;47:979–81.

    Article  CAS  Google Scholar 

  36. McWilliam SJ, Antoine DJ, Smyth RL, Pirmohamed M. Aminoglycoside-induced nephrotoxicity in children. Pediatr Nephrol 2016 [Epub ahead of print].

  37. Zhanel GG. Cephalosporin-induced nephrotoxicity: does it exist? [Review]. DICP 1990;24:262–5.

    Article  CAS  Google Scholar 

  38. Hagos Y, Wolff NA. Assessment of the role of renal organic anion transporters in drug-induced nephrotoxicity. Toxins 2010;2:2055–82.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY, 10032, USA

    Anas A. Minkara BHS, Albert Y. Lin MD, Michael G. Vitale MD, MPH & David P. Roye Jr. MD

Authors
  1. Anas A. Minkara BHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Albert Y. Lin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael G. Vitale MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David P. Roye Jr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David P. Roye Jr. MD.

Additional information

Author disclosures: None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Minkara, A.A., Lin, A.Y., Vitale, M.G. et al. Acute Kidney Injury Secondary to Cell Saver in Posterior Spinal Fusion. Spine Deform 5, 430–434 (2017). https://doi.org/10.1016/j.jspd.2017.03.010

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2017.03.010

Level of Evidence

Keywords

Search

Navigation