Effect Of Intraoperative Autologous Blood Transfusion On Systemic Inflammatory Response And Its Prevention

Background:Perioperative blood loss is still a major problem in elective surgery. Allogeneic blood transfusion is a traditional approach to treat potentially detrimental decreases in hemoglobin (Hb) concentration. Inherent risks in homologous transfusions persist despite all efforts to avoid such events. In addition to well-known risks, such as the transmission of infections, transfusion febrilereactions,transfusion-related acute lung injury, there is some concern about a causal relationship betweenallogeneic red blood cell (RBC) transfusions and immunomodulation. Immunomodulation is an allogeneic blood transfusion related immunosuppression, which is thought to increase the incidence of postoperative infections, delay healing of postoperative wounds, and thereby prolong hospitalization.Alternatives to allogeneic blood transfusion include preoperative autologous donation, acute normovolemic hemodilution and intraoperative or postoperative salvage with autotransfusion.The use of intraoperative cell salvage and autologous blood transfusion has become an important method of blood conservation. The main aim of autologous transfusion is to reduce the need for allogeneic blood transfusion and its associated complications. Incomplete washing can lead to contamination with activated leucocytes, cytokines, and some other microaggregates. Reinfusion of autologous blood can aggravate systemic inflammatory response irritated by surgical trauma. The use of cell salvage in combination with a filter appears to be safe and effective to alleviate systemic inflammatory response, but their efficacy in spinal surgery is unclear. Objective:The aim of this study was to evaluate the effectiveness of intraoperative autologous blood transfusion on systemic inflammatory response.Methods:30consecutive idiopathic scoliosis patients received posterior spinal fusion were randomly assigned into two groups:patients in experimental group received autologous blood transfusion after filtration by Pall LipiGuard SB1, while those in control group received autologous blood transfusion without filtration.The complete blood cell count and the serum levels of IL-6, IL-10and NE were measured at the following occasions:before anesthesia, before reinfusion,2hour,24hour and72hour after reinfusion. The above parameters of autologous blood were also measured before washing, after washing and filtering.Statistical analysis:Results were expressed as mean±standard deviation or mean (25%quantile,75%quantile). The differences between the two groups were compared by generalized linear mixed model with SAS9.2software. A p value less than0.05was considered to be statistically significant.Results:In both groups, White Blood Cell (WBC) count in autologous blood before washing was higher than that before anesthesia (P<0.001), while it was lower after washing and filtration than that before anesthesia (P<0.001). Neutrophils percentage in autologous blood decreased after filtration (P=0.013). Compared with the control group, the IL-6level in experimental group was lower (p=0.001). No clinically relevant complications were encountered in experimental group, However a lung infection and a incision liquefaction in control group.Conclusion:Thereinfusion filter for intraoperative autologous blood transfusion could reduce White Blood Cell count, Neutrophils percentage and the levels of IL-6in autologous blood, which could alleviate postoperative systemic inflammatory response effectively.