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2017, vol. 23, iss. 1, pp. 8-17
Experience in intraoperative autologous blood salvage in pediatric cardiac surgery
aVisoka zdravstvena škola strukovnih studija, Beograd-Zemun
bUniversity of Belgrade, Faculty of Medicine, Institute of Mother and Child Health Care 'dr Vukan Čupić'
cClinical Center of Serbia, Clinic for Hematology, Belgrade
dBolnica 'Sveti Sava', Beograd
eUniversity of Belgrade, Faculty of Medicine, Clinical Hospital Center 'Bežanijska kosa'
fStomatološka ordinacija 'M i M dental office', Niš
gOsnovna škola 'Jajinci' Beograd
Keywords: rescue intraoperative autologous blood; 'Cell-Saver'; 'cost benefit'; allogeneic blood
Introduction/Objectives. The development of modern transfusion as a multidisciplinary science, new information about the safety of blood and blood products (chemo products), as well as the widespread application of blood and/or chemo products (chemotherapy), created the need to develop an alternative to allogeneic blood. Due to the drastic reduction in the number of voluntary blood donors in our country and worldwide has led to the need for the development of alternative strategies for allogeneic blood transfusion. These alternatives include the use of different strategies for autologous transfusion. Display: a) the use of 'Cell-Saver' pediatric cardiac surgery at the Department of Cardiothoracic Surgery, Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic'; b) to analyze the reduced use of allogeneic blood and /or chemo products using 'Cell-Saver' pediatric cardiac surgery; c) to evaluate the 'cost benefit' this strategy e.g. price cost autologous transfusion (e.g. the ratio of prices 'set', 'Cell-Saver') and pretransfusion rates processing one unit of allogeneic blood); d) to identify increased intraoperative security in complex. Reconstructive and redo cardiac surgery using the 'Cell-Saver' combined with ultrafiltration (conventional or modified), particularly in cyanogenic congenital heart defects, and e) to establish and improve the hemodynamic status of hemoreologic operated child. Methods. A retrospective study was conducted at the Department of Cardiothoracic Surgery, Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic' in the period from December 2007 to June 2012. Experimental group included 63 patients (aged 12 days - 16 years and 4 months, body weight of patients that ranged between 2.9 kg and 80 kg - the mean body weight was 28.3 kg). In the experimental group patients were performed following cardiac surgery: 46 patients underwent reconstructive surgery (most often reoperations for cyanogenic congenital heart defects); 3 patients who underwent cardiovascular surgeries were of 'Jehovah's Witnesses' belief, and 3 patients who underwent cardio-surgical procedures had hematological disorders. The control group included 60 patients of similar age and body mass who underwent the cardio-surgical procedure without the use of 'Cell-Saver' with application of allogeneic blood and/or chemo products during transfusion care. During the study accompanied by the following laboratory parameters: hematocrit, platelet count, fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT), after 3, 6, and 12 hours postoperatively compared to the control group. We compared the volume of postoperative bleeding in patients of the experimental group with the control group (1h, 4h, 7h, 11h, 15h, 21h and 24h) and analyzed the amount of used allogeneic and autologous blood and/or hemoglobin products used in the transfusion care during hospitalization the experimental group compared with the control group. Results. Postoperative administration of allogeneic blood and/or hemoproducts was statistically significantly lower in the experimental group using 'Cell- Saver' than in the control group. The amount of salvaged blood after surgery ranged from 210 ml - 620 ml. Intraoperative hematocrit 'rescued' autologous blood ranged between 0.32 l / l and 0.38 l / l. e range of values preoperative and postoperative hematocrit were lower in the experimental group than in the control group that used 'Cell-Saver'. The total volume of postoperative drainage content was significantly lower in the experimental group, which used 'Cell-Saver' compared to the control group. The postoperative hematocrit was higher in the experimental group patients who used 'Cell-Saver' (statistically significant difference), compared with the same operating using allogeneic blood and/or hemoproducts patients in the control group. The mean platelet count, fibrinogen, PT and aPTT results showed no statistically significant difference between the experimental group of patients in whom we used 'Cell-Saver' in comparison to the control group. Conclusion. The results obtained by the retrospective analysis of above mentioned data indicate a positive therapeutic effect of the application of the 'Cell Saver' that is most common in reoperations. With the introduction of the 'bell' of small volume, the use of the Cell Saver has become an integral part of the pediatric cardiac surgery - perfusion, regardless of body weight, age and body surface area of the child. The performance of intraoperative 'rescue' of autologous blood using the 'Cell Saver', while the follow-up of pediatric patients in the perioperative and postoperative period has immeasurable significance of teamwork perfuser, expert specialist nursing, pediatrician, cardiac surgeon and transfusion.


article language: Serbian
document type: Original Paper
published in SCIndeks: 01/06/2017

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