Transfusion
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Obstetric hemorrhage is a leading cause of maternal and perinatal mortality worldwide. Intraoperative blood salvage is common practice in many surgical specialties but its safety in obstetrics is questioned for concerns on the risks of contamination of recovered blood with amniotic fluid (AF) and of maternal-fetal alloimmunization. However, the role of cell salvage as a blood-saving measure in obstetrics is progressively acquiring relevance thanks to the growing body of evidence regarding its quality and safety coming from over 800 documented procedures and more than 400 patients transfused with saved blood. ⋯ The contamination of the SB by fetal Rh-mismatched red blood cells (RBCs) can be dealt with using RhIG; ABO incompatibility tends to be a minor problem since ABO antigens are not fully developed at birth. Antibodies can be formed against other fetal RBC antigens, but it should also be noted that the risk of alloimmunization of the mother from allogeneic transfusion is probably even greater. Therefore, intraoperative cell salvage in obstetrics should be considered in patients at high risk for hemorrhage or in cases where allogeneic blood transfusion is difficult or impossible.
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This study examined the association of hematocrit (Hct) levels measured upon intensive care unit (ICU) admission and red blood cell transfusions to long-term (1-year or 180-day) mortality for both surgical and medical patients. ⋯ Anemia of a Hct level of less than 25% upon admission to the ICU, in the absence of a transfusion, is associated with long-term mortality. Our study suggests that there may be Hct levels below which the transfusion risk-to-benefit imbalance reverses.
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Iron store deficiency is a common side effect of whole blood donation. Early recognition and reversal of excessive iron loss may avoid symptomatic iron store depletion in blood donors and reduce volunteer loss due to iron deficiency (ID) anemia. ⋯ Systematic serum ferritin measurements allowed an optimized management of ID in our donors and efficacious prevention of ID anemia.
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Intraoperative blood salvage is the process whereby shed red blood cells (RBCs) are collected and returned to the patient. We analyzed the trends in the volume of returned RBCs by our blood salvage program across a 12-hospital regional health care system over a 5-year period. ⋯ Although overall the mean volumes of RBCs returned to the patients by intraoperative blood salvage were high, the actual volumes returned depended on the case mix. There appears to be an opportunity to use blood salvage more selectively to improve efficiency.