Recycled Blood Superior to Banked Blood for Surgery

Patients whose own red blood cells (RBCs) are recycled during cardiopulmonary bypass (CPB) surgery fare better than those who get transfusions from a blood bank, according to a new study.

Researchers at Johns Hopkins Medicine (Baltimore, MD, USA) conducted a prospective cohort study involving 32 patients undergoing cardiac surgery with CPB. The patients were divided into three groups by transfusion status: autologous salvaged RBCs alone (12 patients), autologous salvaged RBCs + minimal (less than five units) stored allogeneic RBCs (10 patients), and autologous salvaged RBCs + moderate (more than five units) stored allogeneic RBCs (10 patients). Ektacytometry was used to measure RBC deformability and aggregation before, during, and for three days after surgery.

The results showed that in patients who received only their own RBCs, elongation index did not change significantly from the preoperative baseline. The more blood a patient got from the blood bank, the more their RBCs deformed; deformability was dose-dependent, recovering toward baseline over time. Three days after surgery, however, the RBCs in the group that got the largest number of transfused units still had not recovered their full function. Changes in aggregation were unrelated to transfusion. The study was published in the June 2014 issue of Anesthesia & Analgesia.

“We now have more evidence that fresh blood cells are of a higher quality than what comes from a blood bank,” said lead author Steven Frank, MD, an associate professor of anesthesiology and critical care medicine. “If banked blood, which is stored for up to six weeks, is now shown to be of a lower quality, it makes more sense to use recycled blood that has only been outside the body for one or two hours. It's always been the case that patients feel better about getting their own blood, and recycling is also more cost effective.”

Blood recycling is achieved via a cell saver machine, which collects blood lost during surgery, rinses away unneeded fat and tissue, and then centrifuges and separates the RBCs, which are returned to the patient. Patients who lose blood may also need platelets and plasma, which they receive regardless of whether they receive their own blood or blood from a bank. Recycling first became popular during the early years of the HIV/AIDS crisis, so that patients could avoid the risk of getting the virus in transfused blood. The practice also reduces the risk of contracting hepatitis B or C infections, or of bad transfusion-related reactions.

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