Anesthesia Management: Salvaged Blood Safer, Cheaper than Transfusions, Study Says
This paper was published in the June issue of Anesthesia & Analgesia, the journal of the International Anesthesia Research Society
The use of cell savers to re-circulate blood into surgical patients can deliver higher quality red cells, eliminate transfusion risks, and cost hospitals less than donated units from a blood bank, research finds.
Hospitals should more frequently use cell savers or autologous blood recovery systems to recirculate patients’ own blood instead of transfusing units from a blood bank, a Johns Hopkins researcher suggests. Greater use of cell savers could also save hospitals money, he says.
“We looked at patients who received their own blood that was recycled and given back, and patients who also received blood from the blood bank, and we found that the ones who received their own blood had higher quality red cells after surgery than those who received blood from the blood bank,” says Steven Frank, MD, associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.
Last year, Frank’s research discovered that when donated bloodintended for use in transfusions sits on the shelf, it deteriorates and is less able to carry oxygen after 21 days in a unit’s maximum 42-day unit’s shelf life.
But some physicians and researchers questioned whether the use of cell savers, in which the patient’s own blood that would be lost is pumped out, cleaned and re-circulated back into the patient during surgery, “might beat up the red cells and damage them,” Frank says.
“What we didn’t know before this study was that cell saver blood, or salvaged blood, has better properties, or more membrane deformability, compared to blood banked red cells,” he says.
Frank’s research looked at just 32 patients at Johns Hopkins, but because the study examined only the physiologic properties of the red cells transfused from donor blood or recycled from the patient by the cell saver, he says the result was sufficiently statistically significant for publication.
More studies are in the works to look at other properties of blood units after they have been processed by cells savers.
In the 1980s, when the nation feared infecting patients with viral diseases such as HIV and hepatitis through transfused blood, the cell saver—invented in 1978—was in much greater use, Frank says.
But as the nation’s blood supply has become safer, cell saver usage has dramatically declined. “People think now we don’t need cell savers, because we’ll just get [blood] from the blood bank. The risk of transmitting HIV and hepatitis are now one infection per 2 million units,” Frank says.
But there are risks from transfusion such as transfusion-associated cardiac overload or transfusion-related acute lung injury. And until this paper, there was little awareness about the limited ability of blood that sits on the shelf to circulate to small capillaries in human organs and tissue.
“This should increase awareness of the value of salvaged cell saver blood over blood bank blood,” Frank says.
On the financial end, cell savers may save hospitals money, Frank says. For starters, the disposable setup required for each patient who receives a cell saver is only $120, half the average cost the hospital pays for a unit of blood.
Add to that the cost the hospital incurs to process the unit of blood, label it, type it, transport it, and the cost of treating patients for adverse reactions from it when they occur, and the cost can zoom much higher, he says. A 2010 study estimated the cost of transfusing a unit blood at between $522 and $1,183.
That estimate does not include the cost of treating patients who develop an adverse response or transfusion-related complication and who may require an extended length of stay.
Frank says that for hospitals wanting to know when to use a cell saver and when to use donor blood in surgery, the rule of thumb is this: “If you’re going to transfuse one or more units of red cells, the cell saver pays for itself.” The best bet is to consider cell savers in surgeries that use a lot of blood, such as orthopedic, vascular, and cardiac procedures.
One downside, he says, is that the cell savers require an expert to run them, and that can be a problem for smaller organizations that don’t have a frequent caseload of surgeries with a lot of blood loss.
“Most large academic centers have in-house cell savers (usually anesthesiologists, nurses or perfusionists) but most community hospitals don’t use it enough,” he says. If you don’t have the personnel in house to run the cell saver, you have to contract it to an outside agency and smaller hospitals may find that difficult.”