scholarly journals Extracellular Vesicles in Autologous Cell Salvaged Blood in Orthopedic Surgery

Surgeries ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 84-91
Author(s):  
Maximilian Kutschera ◽  
Agnes Pischlaeger ◽  
Larissa Sztulman ◽  
Sibylle Kietaibl ◽  
Andreas Spittler
Keyword(s):  
Red Blood Cells ◽  
Orthopedic Surgery ◽  
Blood Cells ◽  
Extracellular Vesicle ◽  
Ethics Committee ◽  
Joint Arthroplasty ◽  
Cell Salvage ◽  
Specific Antibodies ◽  
Autologous Cell ◽  
Event Rates

(1) Background: Cell salvage is highly recommended in orthopedic surgery to avoid allogeneic transfusions. Preparational steps during cell salvage may induce extracellular vesicle (EV) formation with potential thrombogenic activity. The purpose of our study was to assess the appearance of EVs at retransfusion. (2) Methods: After ethics committee approval and informed consent, blood was withdrawn from the autotransfusion system (Xtra, Sorin, Germany) of 23 patients undergoing joint arthroplasty. EVs were assessed by flow cytometry in two times centrifugated samples. EVs were stained with specific antibodies against cellular origins from platelets (CD41), myeloid cells (CD15), monocytes (CD14), and erythrocytes (CD235a). The measured events/µL in the flow cytometer were corrected to the number of EVs in the retransfusate. (3) Results: We measured low event rates of EVs from platelets and myeloid origin (<1 event/µL) and from monocytic origin (<2 events/µL). Mean event rates of 17,042 events/µL (range 12–81,164 events/µL) were found for EVs from red blood cells. (4) Conclusion: Retransfusate contains negligible amounts of potentially thrombogenic EVs from platelet and monocytic origin. Frequent EVs from erythrocytes may indicate red blood cell destruction and/or activation during autologous cell salvage. Further research is needed to investigate the clinical relevance of EVs from salvaged red blood cells.

The Incidence And Risk Factors of Serum Hypokalemia After Primary Total Joint Arthroplasty

2021 ◽  
Author(s):  
Pin Pan ◽  
Zitao Zhang ◽  
Xiaofeng Zhang ◽  
Qing Jiang ◽  
Zhihong Xu
Keyword(s):  
Risk Factors ◽  
Red Blood Cells ◽  
Knee Replacement ◽  
Serum Potassium ◽  
Total Joint Arthroplasty ◽  
Blood Cells ◽  
Potassium Level ◽  
Serum Potassium Level ◽  
Joint Arthroplasty ◽  
Regular Monitoring

Abstract Background: Regular monitoring of serum potassium after total joint arthroplasty (TJA) is a routine examination, which can detect abnormal serum potassium and reduce adverse events timely caused by postoperative hypokalemia. In this study, we aimed to investigate the incidence and risk factors of hypokalemia after primary total hip and knee replacement.Methods: This study included patients who underwent unilateral total knee or hip arthroplasty in our department from April 2017 to March 2018. The serum potassium level before and after operation was collected and retrospectively analyzed. The differences in age, BMI and other factors between hypokalemia patients and non-hypokalemia patients at different time points after surgery were compared, and then the risk factors of postoperative hypokalemia were analyzed based on multiple logistic regression.Results: The total incidence of postoperative hypokalemia was 53.1%, while the respective rate on the first, third and fifth postoperative day was 12.5%, 40.7% and 9.6%. The serum potassium level on the first, third and fifth postoperative day was 3.84±0.32mmol/l, 3.59±0.34mmol/l and 3.80±0.32mmol/l, while among which, the level on the third day was the lowest (p=0.015). The independent risk factors for hypokalemia after total hip and knee replacement were the level of preoperative serum potassium (p=0.011), preoperative red blood cells (p=0.027), and a history of diabetes (p=0.007).Conclusion: Regular monitoring of serum potassium should be performed after TJA due to hypokalemia was a very common complication. We need to pay more attention to patients’ preoperative potassium and red blood cells, especially patients with diabetes.

Phagocytosis of Foreign Red Blood Cells by the Reticulo-Endothelial System

1957 ◽  
Vol 189 (3) ◽  
pp. 520-526 ◽  
Author(s):  
Bernard N. Halpern ◽  
G. Biozzi ◽  
B. Benacerraf ◽  
C. Stiffel
Keyword(s):  
Endothelial Cells ◽  
Red Blood Cells ◽  
Clearance Rate ◽  
Blood Cells ◽  
Red Cell ◽  
Histological Evidence ◽  
Specific Antibodies ◽  
Cell Counts ◽  
India Ink ◽  
Reticulo Endothelial System

The clearance rate of nucleated pigeon erythrocytes injected intravenously into mice and rats has been calculated either by routine differential red cell counts or by measuring the radioactivity of the erythrocytes tagged with P32. Histological evidence is given that the foreign erythrocytes are phagocytized by the reticulo-endothelial cells of the liver and spleen. The clearance rate of the foreign erythrocytes, which measures the speed of the phagocytosis, follows in mice a regular exponential function similar to this previously established for other colloids. No spontaneous antibodies to pigeon erythrocytes could be detected in mice. The rapid and complex clearance rate of pigeon erythrocytes observed in rats is related to the existence of spontaneous specific antibodies. The simultaneous injection of pigeon erythrocytes and of India ink into mice, both phagocytized by the RE cells, results in a competition between the two substances in favor of the smaller particles of carbon.

Abstracts for the British Congenital Cardiac Association Annual Meeting: The Barbican, London, 24–25 November 2005: Oral Presentations: Perioperative red cell salvage in paediatric cardiac surgery

2006 ◽  
Vol 16 (3) ◽  
pp. 316-316
Author(s):  
S. Salam ◽  
D. Abrams ◽  
A. Kelleher ◽  
J. La Rovere
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Red Cell ◽  
Infectious Agents ◽  
Cell Salvage ◽  
Blood Products ◽  
Potential Health ◽  
Transfusion Requirements

Objective: In recent years blood transfusion has become a debated health care issue. To minimise exposure to infectious agents and reduce bank blood transfusion requirements, leucocyte filtration and perioperative red cell salvage (RCS) are increasingly used in paediatric patients. We hypothesised RCS would reduce the need for additional blood products in children following cardiopulmonary bypass (CPB). Methods: Patients undergoing routine or emergency cardiac surgery requiring CPB over a study period of 3 months were included prospectively in the analysis. Haemoglobin, platelet count, coagulation screen and heparin levels were performed before, immediately after surgery and 24 hours later. RCS was performed in theatre according to surgical and anaesthetic preference. Red cells were salvaged from the surgical site, anticoagulated, washed and following resuspension in saline reinfused into the patient within 4 hours. The incidence of post-operative bleeding (>10 ml/kg/hr) was recorded, as was the need for additional red blood cells, platelets and fresh frozen plasma (FFP). The need for blood products was at the discretion of the consultant intensivist. Statistical analysis was performed using student t-test and Chi squared methods. Significance was accepted as p < 0.05. Results: Thirty-five consecutive patients (34.54 ± 43.55 months, 13.48 ± 14.39 kg) were included in the analysis. A total of 17 infants <12 months were included, 9/24 who received RCS and 8/11 who did not (p 0.052). Cyanotic heart disease was seen in 40%. RCS was performed in 24 of 35 patients, who were significantly older (44.2 ± 44.1 vs. 13.6 ± 25.5, p 0.02) and heavier (16.6 ± 16.2 vs. 6.7 ± 4.7, p 0.01). No difference was seen in the prevalence of cyanosis between the two groups. Post-operative bleeding was seen in 21% who underwent RCS and 40% in those who did not (p 0.33). The need for additional red blood cells was significantly reduced in those who received RCS, 37.5% vs. 91%, p 0.003, as was the use of FFP, 8.3% vs. 45.5%, p 0.02. There was no difference in the need for platelet transfusion, p 0.2. Discussion: In this study RCS was performed on 68.5% of children following CPB. RCS significantly reduced the need for further blood and FFP transfusion, although this was not related to post-operative bleeding. This has important implications for both exposure to infectious agents and health economics. That children who underwent RCS were older and heavier may be related to the complexity of surgery and CPB in younger patients, although infants were represented in both groups. A further analysis of potential health and economic benefits in a homogenous group is needed.

Screening of red blood cells for extracellular vesicle content as a product quality indicator

Transfusion ◽  
2018 ◽  
Vol 58 (9) ◽  
pp. 2217-2226 ◽  
Author(s):  
Jason P. Acker ◽  
Ruqayyah J. Almizraq ◽  
Daniel Millar ◽  
Elisabeth Maurer-Spurej
Keyword(s):  
Red Blood Cells ◽  
Product Quality ◽  
Blood Cells ◽  
Quality Indicator ◽  
Extracellular Vesicle ◽  
Vesicle Content

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

2015 ◽  
Vol 10 (5) ◽  
pp. 334-341 ◽  
Author(s):  
Pankaj Garg ◽  
Amber Malhotra ◽  
Manan Desai ◽  
Pranav Sharma ◽  
Arvind Kumar Bishnoi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Artery Bypass ◽  
Osmotic Fragility ◽  
Limiting Factor ◽  
Cell Saver ◽  
Cell Salvage ◽  
Free Hemoglobin ◽  
Surgical Field

Objective Cell Saver system is the method of choice for red blood cell salvage from the surgical field; however, cost is a limiting factor. We at our institute have devised a cost-effective version of dialyser-based autotransfusion system. We performed pretransfusion comparison of our autotransfusion system with conventional cell saver system. Methods A prospective randomized observational study was performed in 104 consecutive patients with coronary artery disease undergoing by off-pump coronary artery bypass grafting. Patients were divided into two groups. In the dialyser group (53 patients), blood from surgical field was salvaged by our dialyser-based system. In the cell saver group (51 patients), blood was salvaged by cell saver. In both groups, 20-mL sample from the salvaged blood was analyzed for hemoglobin, platelets, protein, albumin, free hemoglobin, osmotic fragility, and peripheral blood smear examination. Results Total hemoglobin salvaged was comparable in both groups (85% vs 76%). On peripheral smear, red blood cells were swollen, but morphology was preserved. Moreover, normal osmotic fragility suggested absence of any lethal damage to red blood cells in either group. Dialyser-based system was more efficient in salvaging platelets (42.9% vs 6%), proteins (79.2% vs 0%), and albumin (65% vs 0%). Total free hemoglobin was three times more in dialyser group but was well below recommended limits. Conclusions Dialyser-based system is economical, is equally efficacious in salvaging red blood cells, is more effective in salvaging platelets and proteins, and does not contain significant amount of free hemoglobin. Therefore, this salvaged blood can be safely transfused.

scholarly journals Occurrence of allogeneic HLA and non-HLA antibodies after transfusion of prestorage filtered platelets and red blood cells: a prospective study [see comments]

Blood ◽  
1995 ◽  
Vol 85 (7) ◽  
pp. 1736-1741 ◽  
Author(s):  
VM Novotny ◽  
R van Doorn ◽  
MD Witvliet ◽  
FH Claas ◽  
A Brand
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Specific Antigen ◽  
Blood Transfusions ◽  
Hla Antibodies ◽  
Specific Antibodies ◽  
Leukocyte Depletion ◽  
Entire Duration ◽  
History Of ◽  
A Prospective Study

The incidence and consequences of HLA and non-HLA immunization were evaluated in 229 patients with aplastic thrombocytopenia. All patients were transfused with prestorage filtered red blood cells and platelets. On admission, 29 patients presented with HLA antibodies due to prior immunization by pregnancy and/or blood transfusions. Of the 200 patients showing no detectable HLA antibodies on admission, 164 could be evaluated. HLA antibodies developed in 2.7% (3 of 112) of the patients with a negative risk history of prior immunization. The occurrence of HLA antibodies in patients with a history of previous pregnancies or prior non-leukocyte-depleted blood transfusions (risk history positive) was 31% (16 of 52). Of the total of 48 patients who were or became alloimmunized, 92% (44 of 48) had a positive risk history. Ten patients with broad multispecific HLA antibodies with a panel reactivity (PRA) of greater than 70% required transfusions with HLA-matched platelets. Patients with HLA antibodies with lower PRA could be supported by random donor platelets. Two patients developed platelet-specific antibodies, causing transfusion refractoriness that necessitated selecting platelets by the absence of a platelet-specific antigen. Using prestorage leukocyte depletion of red cells and platelets with less than 5 x 10(6) residual leukocytes, 95% of the patients, including patients with a previous risk history or with HLA antibodies with low PRA, can be supported with random donor transfusions for the entire duration of their thrombocytopenic periods.

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