Balancing the Blood Component Transfusion Ratio for High- and Ultra High–Dose Cell Salvage Cases

Kevin R. Merkel, Sophia D. Lin, Steven M. Frank, Tymoteusz J. Kajstura, Nicolas C. Cruz, Brian D. Lo, James H. Black, Eric A. Gehrie, Nadia B. Hensley, Brian C. Cho, Laeben C. Lester

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess the ratio of non-red blood cell to red blood cell components required to avoid coagulopathy when transfusing large amounts of salvaged blood using laboratory test–guided therapy. Design: Retrospective cohort study. Setting: Single-center, academic hospital. Participants: Thoracoabdominal and abdominal open aortic surgery patients. Measurement and Main Results: Thirty-eight patients in whom at least 1,000 mL of salvaged red blood cells were transfused were identified and divided into the following 2 cohorts: 1,000-to-2,000 mL of salvaged red blood cells (high dose) (n = 20) and >2,000 mL of salvaged red blood cells (ultra-high dose) (n = 18). Compared with the high-dose cohort, the ultra high-dose cohort received ∼4 times more salvaged red blood cells (1,240 ± 279 mL v 5,550 ± 3,801 mL). With transfusion therapy guided by intraoperative coagulation tests and thromboelastography, the adjusted ratio of non-red blood cell to red blood cell components (plasma + platelets + cryoprecipitate:allogeneic + salvaged red blood cells) was 0.59 ± 0.66 in the high-dose and 0.93 ± 0.27 in the ultra high-dose cohorts. Multiple coagulation parameters were normal and similar between cohorts at the end of surgery, as determined by the mean, median, and 95% confidence intervals. Conclusions: When transfusing large volumes of salvaged blood, it is important to balance the ratio between non-red blood cell and red blood cell components. Through a laboratory test–guided approach, coagulopathy was not detected when transfusing blood in ratios of approximately 1:2 for patients receiving 1,000-to-2,000 mL of salvaged blood and 1:1 for patients receiving >2,000 mL of salvaged blood.

Original languageEnglish (US)
JournalJournal of cardiothoracic and vascular anesthesia
DOIs
StateAccepted/In press - 2020

Keywords

  • blood
  • cell
  • coagulopathy
  • ratio
  • salvage
  • surgery
  • vascular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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