Using Cell Saver Device to Wash PRBCs

[deleted9493]

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Does anybody have any experience doing this for pediatric patients who are likely to require significant transfusion? Today was the first I had heard of the idea, apart from what perfusionists will do for CPB. My initial reaction was that it seemed like a lot of hassle to take a step that the blood bank will already do for us (and potentially an inefficient use of red cells), but I'm having trouble finding any literature that speaks to the counterpoint that it's a good idea.

My tendency right now is to ask for young, washed blood, reconstitute with FFP and put it on a pump adjusting the rate as needed in infants having big whacks. I can't say that I've seen much in the way of hyperkalemia by blood gases using this strategy.

That said, I'm eager to hear what others here do/know and whether or not anyone has any literature that speaks to this issue.

 

[cchoukal]

You could probably pubmed this, but I know it's been done. I had an attending in residency who would do this during liver transplants to reduce the K-load of the massive transfusion. He presented a couple abstracts/posters on it, but I'm not sure what's out there in the published literature.

 

[IlDestriero]

Does anybody have any experience doing this for pediatric patients who are likely to require significant transfusion? Today was the first I had heard of the idea, apart from what perfusionists will do for CPB. My initial reaction was that it seemed like a lot of hassle to take a step that the blood bank will already do for us (and potentially an inefficient use of red cells), but I'm having trouble finding any literature that speaks to the counterpoint that it's a good idea.

My tendency right now is to ask for young, washed blood, reconstitute with FFP and put it on a pump adjusting the rate as needed in infants having big whacks. I can't say that I've seen much in the way of hyperkalemia by blood gases using this strategy.

That said, I'm eager to hear what others here do/know and whether or not anyone has any literature that speaks to this issue.

Why wash the blood when the blood bank can do it for you? Can we do it faster than the bank? Who would do it, us or the technician? If you're doing a case that requires this much prep, you're probably too busy doing other things and watching the bleeding. I'm doing a cell saver case tomorrow, I'll ask the guy if he's ever heard of/done it before.
The young reconstituted blood is what we use for craniofacial when whole blood is not available. They match the donor FFP and PRBCs for us.
Whole blood is the bomb.

 

[jwk]

Once you've washed blood through the cellsaver, all you have remaining is a suspension of RBC's and saline - no clotting factors. I understand the preference for using whole blood in selected cases, but I'm not in a peds center, so I'm not familiar with why you would want to use just washed RBC's.

 

[cchoukal]

The rationale I've been given is speed. During a massive transfusion, the time it takes for the blood bank to wash the cells exceeds the that of the cellsaver. The technician would do it.

And while it's true that you're left with a suspension of RBCs in saline (and some heparin, I've been told), that's also true of washed RBCs from the bank.

 

[deleted9493]

Why wash the blood when the blood bank can do it for you? Can we do it faster than the bank? Who would do it, us or the technician? If you're doing a case that requires this much prep, you're probably too busy doing other things and watching the bleeding. I'm doing a cell saver case tomorrow, I'll ask the guy if he's ever heard of/done it before.
The young reconstituted blood is what we use for craniofacial when whole blood is not available. They match the donor FFP and PRBCs for us.
Whole blood is the bomb.

This was my reaction. I mean, if I anticipate needing 4 full units of blood in an infant, I'd rather just have them washed in the blood bank and sent to the room, rather than dedicating resources to washing them through a saver in the OR, myself.

At any rate, we tried it today and the cell saver took a unit of PRBCs from a K of 10mEq/L to 1. I ended up transfusing re-constituted blood/ffp as needed through a big liver tumor resection with right atrial tumor (hepatoblastoma) requiring a short bypass run today. I just didn't know if there was any data speaking to the value of washing the packed cells in the OR versus having them do it in the blood bank.

Agreed, regarding whole blood.

 

[urge]

Does anybody have any experience doing this for pediatric patients who are likely to require significant transfusion? Today was the first I had heard of the idea, apart from what perfusionists will do for CPB. My initial reaction was that it seemed like a lot of hassle to take a step that the blood bank will already do for us (and potentially an inefficient use of red cells), but I'm having trouble finding any literature that speaks to the counterpoint that it's a good idea.

My tendency right now is to ask for young, washed blood, reconstitute with FFP and put it on a pump adjusting the rate as needed in infants having big whacks. I can't say that I've seen much in the way of hyperkalemia by blood gases using this strategy.

That said, I'm eager to hear what others here do/know and whether or not anyone has any literature that speaks to this issue.

We do it fairly often when cell saver is used for the case. Otherwise we have the blood bank do it but it takes them like 3 hrs. Our blood bank is pretty bad.

I'm not sure why you need to see a paper on it. It's just RBCs being washed.

Do you need to see a paper before taking a bath?

 

[deleted9493]

We do it fairly often when cell saver is used for the case. Otherwise we have the blood bank do it but it takes them like 3 hrs. Our blood bank is pretty bad.

I'm not sure why you need to see a paper on it. It's just RBCs being washed.

Do you need to see a paper before taking a bath?

Ok, so child has tumor throughout the liver and up into the RA. Cell saver not being planned for the case for that reason. It was suggested to use the saver expressly for the purpose of washing red cells. I have typically just asked the lab to do the washing but was looking for reasons to change my current practice, if warranted.

 

[urge]

Ok, so child has tumor throughout the liver and up into the RA. Cell saver not being planned for the case for that reason. It was suggested to use the saver expressly for the purpose of washing red cells. I have typically just asked the lab to do the washing but was looking for reasons to change my current practice, if warranted.

It"s just a matter of how good or bad your blood bank is.

 

[IlDestriero]

Our wash time is 45 minutes. If we can do it in the OR in 10 min, that might be helpful in an emergency.
It would be useful to know how the blood bank washes it vs the cell saver, and how difficult it is to F it up by accident or if there is extra cell trauma, etc. I imagine there would be a difference in fragility of banked blood and cell salvaged fresh blood.