J Extra Corpor Technol 2025, 57, 89 – 95 Ó The Author( s), published by EDP Sciences, 2025 https:// doi. org / 10.1051 / ject / 2025013
Available online at: ject. edpsciences. org
ORIGINAL ARTICLE
Hematocrit and total protein elimination as quality control parameters of cell salvage
Debora Dörffel 1,*, Edda Klotz( Dr. med.) 2, Patrick Wagner( Dr. med.) 3, Karsten Ehrig( Dr.) 1 Karin Pretzel 1, Falko Hanisch 1, and Axel Pruß( Prof. Dr.) 1
1 Institute of Transfusion Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany 2 Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité –
Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany 3 Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200 Berlin, Germany Received 20 November 2024, Accepted 17 April 2025
Abstract – Background: The use of cell salvage reduces homologous blood transfusions during operations and avoids associated complications. Therefore, autotransfusion is an integral part of Patient Blood Management( PBM). The quality control of cell salvage in Germany is performed by checking the target values of a hematocrit in the autotransfusion blood( target: over 50 %) and a total protein elimination( target: over 90 %). The aim of this study was to identify intraoperative circumstances leading to deviations from the target values. Methods: This retrospective data analysis includes the use of the cell saver at the Charité – Universitätsmedizin Berlin, Campus Charité Mitte and Campus Benjamin Franklin from 01.01.2019 to 29.03.2022, in which autotransfusion occurred. In addition to the hematocrit and total protein elimination, the age and gender of the patients, as well as the surgical diagnosis, were included to investigate possible factors influencing compliance with the target values. The data were statistically analyzed using SPSS. Results: A total patient collective of 238 cell salvage applications( 154 men, 84 women) was examined. The target values for quality control were achieved on average. The target value for hematocrit was not achieved in about 22 % and for total protein elimination in about 8 % of cell salvage applications. The age and gender of the patient, as well as the surgical diagnosis, had very little to no influence on compliance with the target values. The target values were not met primarily when the emergency option of the cell saver was used, when the collection volume was too low or when the collection volume was heavily diluted with rinsing fluid. Conclusion: The target values for quality control were achieved in most of the cell salvage applications examined and are suitable for ensuring the quality of autotransfusion. Special clinical circumstances may lead to the treating anesthetist having to accept deviating collection volumes or washing processes.
Key words: Blood transfusion, Autotransfusion, Intraoperative cell salvage, Quality control.
Introduction
* Corresponding author: debora. doerffel @ outlook. com
Red blood cell( RBC) concentrates are transfused primarily in cases of acute hemorrhage or chronic anemia to prevent tissue hypoxia [ 1 ]. Due to demographic changes with an increase in the proportion of older people with an increasing risk of illness and therefore transfusion, the demand for RBC concentrates will increase in the future [ 2 – 4 ]. In 2010, the WHO recommended the implementation of Patient Blood Management( PBM) [ 5 ], which is based on the prevention and early treatment of anemia or coagulopathy, the avoidance of unnecessary blood loss using minimally invasive procedures and the reduction of iatrogenic blood loss, as well as the use of automated autotransfusion and individual decision-making regarding allogeneic blood products, considering patient-specific anemia tolerance [ 6 ]. Thus, automated autotransfusion is an integral part of PBM. Allogeneic blood transfusions hold numerous disadvantages compared to autologous blood transfusions: seasonally lower availability, potential transmission of infections, and non-infectious risks. In high-income countries, non-infectious risks predominate [ 7 ]. The most serious complications and the majority of deaths are caused by pulmonary complications, such as transfusion-related acute lung injury and transfusion-associated circulatory overload [ 8 ]. In addition, allogeneic transfusions can lead to allergic reactions [ 9 ]. The rate of adverse reactions to allogeneic transfusions is approximately 1.9 in 1000, of which 43 % are allergic transfusion reactions. Although 97 % of these allergic transfusion reactions are
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