Methods of Blood Loss Replacement in Emergency Neurosurgery

A.A. Sakharova, Yu.S. Ioffe, V.V. Krylov, V.V. Lebedev, V.B. Khvatov, A.A. Grin

Sklifosovsky Research Institute of Emergency Care, Moscow, Russia

 

Emergency interventions in such pathology, as craniocerebral trauma, non-traumatic intracranial hemorrhages and spinal trauma are often accompanied by massive bleeding. It is known, that considerable blood loss conditions a more severe course of a postoperative period.

The goal of the present study was estimation of efficacy of autoinfusion in blood loss replacement.

Materials and Methods. There were 365 cases, operated for acute craniocerebral trauma, arterial aneurysms, AVM and spinal trauma. Autoblood and its components were used in 89 patients with intraoperative blood loss of 0.5-3.2 l (a mean value - 1.2±0.14 l).

Results. Preoperative taking of autoblood (PTAB) was carried out in 35 patients (3-5 and more days before operation). Normovolemic hemodilution (NVH) was used in 14 cases with a short preoperative period (1-2 days). Intraoperative apparatus reinfusion of blood (IARB) with applying Cell Saver CATS and combined methods of blood loss replacement were used in 24 and 16 cases respectively. We resorted to PTAB and NVH in planned and delayed interventions. IARB was used both in planned and emergency operations. PTAB and IARB were carried out in 39% and 27% of cases. Combined methods allowed to give up using allogenic blood in a preoperative period.

Generalized information is presented in Table.

A Spectrum of Autotransfusion Media and Methods of Their Obtaining in Neurosurgical Practice

 

Autotransfusion Media

A Method of Obtaining

A Number of Patients
abs.%

Banked Blood*
l SDE

Packed Red Cells
l SDE

A Cellular Component
l SDE

Plasma
l doses

PTAB

35 - 39

1750±3.4

8250±16.1

-

6800±27.2

NVH

14 - 16

7250±14.2

-

-

-

IARB

24 - 27

102350±97.2

-

24550±88.4

-

Combined methods

16 - 18

36450±34.6

1250±2.4

7780±28.0

1300±5.2

Total:

89 - 100

147800±149.4

9500±18.5

32330±116.4

8100±32.4

 

76.6 l as an equivalent of donor blood

-

Note: A cellular component contains erythrocytes, leukocytes and thrombocytes. SDE - a standard dose of erythrocytes, equal to 200±10 ml with hematocrit of 1.0 (100 vol.%), which is equivalent to 450±25 ml of whole blood or 513±50 ml of banked donor blood. A dose of fresh frozen plasma corresponds to 250 ml;
* - including non-separated and diluted autoblood. We used 76.6 l of autoblood (as an equivalent of donor blood) in 89 cases.

We tried to objectivize registered blood loss for its adequate replacement. Globular volume deficit and coagulation potential were replaced by media, containing autoerythrocytes, and auto- and donor plasma respectively.

Thus, the described approach to a choice autotransfusion therapy can be regarded as a transfusion component of "bloodless" neurosurgery, i.e. maximum use of autoblood and minimum use of allogeic blood. It leads to reduction of posttransfusion complications, conditioned by transmission of infections with blood, alloimmunization and immunosuppression.

The above methods of prevention of bleeding during operation reduced blood loss in patients with acute neurosurgical pathology to a considerable extent and had a positive effect on disease outcome.

Conclusion. Use of modalities, permitting to reduce intraoperative blood loss, as well as methods of storing autoblood and individual planning of operations made it possible to give up transfusion of allogenic conserved blood in 80% and 96% of cases with acute and planned neurosurgical pathology respectively.