Intervention Review

Cell salvage for minimising perioperative allogeneic blood transfusion

  1. Paul A Carless1,*,
  2. David A Henry2,
  3. Annette J Moxey3,
  4. Dianne O'Connell4,
  5. Tamara Brown5,
  6. Dean A Fergusson6

Editorial Group: Cochrane Injuries Group

Published Online: 14 APR 2010

Assessed as up-to-date: 2 JUN 2009

DOI: 10.1002/14651858.CD001888.pub4

Database Title

Additional Information

How to Cite

Carless PA, Henry DA, Moxey AJ, O'Connell D, Brown T, Fergusson DA. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD001888. DOI: 10.1002/14651858.CD001888.pub4.

Author Information

  1. 1

    Faculty of Health, University of Newcastle, Discipline of Clinical Pharmacology, Newcastle, New South Wales, Australia

  2. 2

    Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada

  3. 3

    Faculty of Health, University of Newcastle, Research Centre for Gender, Health & Ageing, Callaghan, New South Wales, Australia

  4. 4

    Cancer Council, Cancer Epidemiology Research Unit, Sydney, NSW, Australia

  5. 5

    University of Teesside, School of Health & Social Care, Centre for Food, Physical Activity and Obesity, Middlesbrough, UK

  6. 6

    University of Ottawa Centre for Transfusion Research, Ottawa Health Research Institute, Ottawa, Ontario, Canada

*Paul A Carless, Discipline of Clinical Pharmacology, Faculty of Health, University of Newcastle, Level 5, Clinical Sciences Building, Newcastle Mater Hospital, Edith Street, Waratah, Newcastle, New South Wales, 2298, Australia. Paul.Carless@newcastle.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 14 APR 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Concerns regarding the safety of transfused blood have prompted reconsideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques to minimise transfusion requirements.

Objectives

To examine the evidence for the efficacy of cell salvage in reducing allogeneic blood transfusion and the evidence for any effect on clinical outcomes.

Search methods

We identified studies by searching CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the internet (to August 2009) and bibliographies of published articles.

Selection criteria

Randomised controlled trials with a concurrent control group in which adult patients, scheduled for non-urgent surgery, were randomised to cell salvage (autotransfusion) or to a control group who did not receive the intervention.

Data collection and analysis

Data were independently extracted and the risk of bias assessed. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random-effects model. The primary outcomes were the number of patients exposed to allogeneic red cell transfusion and the amount of blood transfused. Other clinical outcomes are detailed in the review.

Main results

A total of 75 trials were included. Overall, the use of cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 38% (RR 0.62; 95% CI 0.55 to 0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to 0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage resulted in an average saving of 0.68 units of allogeneic RBC per patient (WMD -0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact adversely on clinical outcomes.

Authors' conclusions

The results suggest cell salvage is efficacious in reducing the need for allogeneic red cell transfusion in adult elective cardiac and orthopaedic surgery. The use of cell salvage did not appear to impact adversely on clinical outcomes. However, the methodological quality of trials was poor. As the trials were unblinded and lacked adequate concealment of treatment allocation, transfusion practices may have been influenced by knowledge of the patients' treatment status potentially biasing the results in favour of cell salvage.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Cell salvage (collecting a patient's own blood during surgery) for reducing transfusions with donated blood

Some patients who undergo surgery require blood transfusions to compensate for the blood loss that occurs during the procedure. Often the blood used for the transfusion has been donated by a volunteer. The risks associated with receiving volunteer donor blood that has been screened by a competently managed modern laboratory are considered minimal, with the risk of contracting diseases such as HIV and hepatitis C being extremely low. However there is concern in many developing countries, where there is a high prevalence of such infections and transfusion services are inadequately equipped to screen donor blood as thoroughly. Although in developed countries the risks of acquiring a disease from transfused blood are low, the financial costs associated with providing a safe and reliable blood product are escalating. Therefore there is much attention being placed on alternative strategies to minimise the need for transfusions of donor blood.

'Cell salvage' or 'autotransfusion' is one technique designed to reduce the use of such transfusions. It involves the collection of a patient's own blood from surgical sites which can be transfused back into the same person during or after surgery, as required.

The authors undertook this systematic review to examine the evidence for the effectiveness of cell salvage in reducing the need for blood transfusions of donor blood in adults (over 18 years) undergoing surgery.

The authors found 75 studies investigating the effectiveness of cell salvage in orthopaedic (36 studies), cardiac (33 studies), and vascular (6 studies) surgery. Overall, the findings show that cell salvage reduces the need for transfusions of donated blood. The authors conclude that there appears to be sufficient evidence to support the use of cell salvage in cardiac and orthopaedic surgery. Cell salvage does not appear to cause any adverse clinical outcomes.

As the methodological quality of the trials was poor, the findings may be biased in favour of cell salvage. Large trials of high methodological quality that assess the relative effectiveness, safety, and cost-effectiveness of cell salvage in different surgical procedures should be the focus of future research in this area.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

減少異體輸血的手術前後的自體輸血(cell salvage)

有關輸血安全性的顧慮，已促使異體(血液來自非親緣之供給者)紅血球(RBC)輸血與降低輸血需要的相關技術之再審議。

目標

為了檢視以自體輸血減少異體輸血的效益的證據，以及臨床結果上具有任何效果的證據。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials, MEDLINE與全球衛生技術評估機構的網站。同時也搜尋所找到的試驗與回顧文章中的參考文獻清單，並聯絡研究作者以找尋其他的研究。搜尋最後更新於2004年1月。

選擇標準

將接受非急診手術的成人病患隨機分配到自體輸血與沒有自體輸血的對照組的平行對照臨床試驗。

資料收集與分析

作者分別檢閱搜尋結果，擷取資料並評估方法學的品質。主要結果的測量是患者經歷異體紅血球輸血的人數以及其輸血量。其他結果的測量包括因流血的再次手術、失血量、術後併發症(血栓、感染、非致死性的心肌梗塞、腎衰竭)、死亡率和住院天數(length of hospital stay, LOS)。

主要結論

總結來說，自體輸血可以減少39%患者經歷異體紅血球輸血的比例(relative risk [RR] = 0.61: 95% confidence interval [CI] 0.52 to 0.71)。接受異體紅血球輸血的absolute reduction in risk (ARR)為23%(95% CI 16% to 30%)。在骨科的手術中，患者經歷紅血球輸血的RR為0.42(95% CI 0.32 to 0.54)；而心臟手術中經歷紅血球輸血的RR則為0.77(95% CI 0.68 to 0.87)。使用血球挽回術使得每位患者平均節省0.67單位的異體紅血球(加權的平均差為0.64; 95% CI −0.89 to −0.45)。血球挽回術並未對臨床結果產生不利影響。

作者結論

本結果認為在成人常規性手術中，自體輸血對於降低異體紅血球輸血的需要是有效的。然而，試驗的方法學品質是不佳的。因為試驗為非盲目且未適度隱藏治療方法的分派。輸血的執行也許會受病患對於治療狀態的認知所致之偏差所影響，造成結果偏向於血球挽回術。

翻譯人

本摘要由高雄榮民總醫院徐圭璋翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

當需要輸血的時候，自體輸血，即手術期間收集病患自身血液以輸回病患，是一種依賴供給者血液的替代方法。然而，這種用來減少供給者血液輸血過程效果的證據在哪裡?某些病患在經歷手術時需要輸血以補償手術過程中發生失血；通常用來輸血的血液是由自願者捐贈。通過接受自願者捐贈的血液而產生的風險是很小的，尤其其血液已經由有效管理的現代實驗室徹底檢驗過，而罹患如HIV或C型肝炎等疾病的風險更是極度低的。雖然如此，在許多這類感染病盛行率頗高的發展中國家，其輸血服務沒有適當的設備去徹底檢驗捐贈者的血液，則輸血仍有其隱憂。雖然在已開發國家因為輸血而罹患疾病的風險較低，其有關提供安全且可信的血液製品財務成本是逐漸上揚的。因此，可以減少捐贈者血液輸血的替代策略就備受關注。“自體輸血”(Cell salvage)就是一種設計來減少這種輸血的技術。它涉及收集病患本身來自手術部位的血液，在手術期間或術後需要的時候可以輸回同一人身上。作者執行系統性的回顧，以評估有關成人(18歲以上)接受手術時，自體輸血是否能減少輸捐贈者血液的效果的證據。作者找到51篇探討血液挽回術效果的研究，其中包括心臟外科(23篇研究)、骨科(23篇研究)與血管外科(5篇研究)。整體來說，結果顯示自體輸血能夠減少輸捐贈者血液的需要。作者結論為，看來有足夠的證據支持心臟與骨科的手術中使用自體輸血。自體輸血看來不會造成任何負面的臨床結果。由於試驗的方法學的品質較差，所有的發現也許因此而偏好自體輸血。大型具有高品質的方法學試驗來評估不同手術過程自體輸血的相對效果、安全性和成本效果，應該是這個領域未來研究的重點。

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