Innovative technology for recovery of perioperative blood loss
13 January 2025
13 January 2025
The "Oberig" clinic successfully applied intraoperative irradiation of lost blood (erythrocyte mass) with Cell-saver and its transfusion instead of massive transfusion of "alien" blood during liver transplantation in a recipient with oncological disease.
Liver transplantation from a living related donor and from a cadaver donor has gained wide development in Ukraine over the past few years. The survival of patients after liver transplantation largely depends on perioperative anesthetic management.
One of the challenges is intraoperative blood loss. The tendency of patients with terminal stage liver disease to bleed is a well-known fact. And the need for massive intraoperative transfusion of "alien" blood is an important risk factor for mortality after many major surgical interventions, including liver transplantation. There are studies that indicate that transfusion of "foreign" red blood cell mass during surgery can contribute to or exacerbate graft dysfunction in the early postoperative period.
To avoid highly probable complications, intraoperative red blood cell savagery is used. The patient's blood, which is lost during surgery, is collected by suction into a device called a cell-saver, which washes the patient's red blood cells and makes them suitable for re-infusion. The entire process can take several minutes.
The presence of oncological diseases in patients may limit the use of intraoperative red blood cell savagery. One of the main problems with this approach is the presence of tumor cells in the blood collected from the surgical field. This creates a risk of systemic dissemination of tumor cells, which can potentially contribute to the development of metastases or disease recurrence. At present, this is not an absolute contraindication to the use of red blood cell recovery, but the current evidence base is limited in size and quality, so high-quality randomized controlled trials are needed.
The solution to this problem is intraoperative irradiation of recovered red blood cells during surgery with a dose of 50 Gy. Irradiation allows for effective inactivation of metastatic cells, ensuring the safe return of the patient's "own" red blood cell mass.
This method was successfully implemented in our clinic "Oberig". Intraoperative blood loss was almost 5 liters of blood. At the same time, by means of irradiation of red blood cell mass with cell-saver, we managed to avoid massive transfusion of donor blood and related complications.