Page 48 Daily Mail, Tuesday, August 13, 2019
S
ince the early 20th century,
using one person’s blood to
replace another’s lost blood
has been a routine part of
surgical life.
But donated blood is a precious resource.
With 400 new donors a day needed to meet
demand in the UK, shortages can occur,
and it can be a race against time to find
donations for those with rare blood types.
At around £150 a unit (just less than a
pint), donated blood is also relatively
expensive and transfusions are not without
risk. Although all donated blood is tested
for viruses including HiV and hepatitis c,
there is still a very low risk of infection.
Potentially fatal reactions to donated
blood can also occur.
So it is perhaps no surprise that hospitals
are being urged to consider an alternative:
turning patients into their own donors. in a
process known as cell salvage, blood lost by
a patient during surgery is washed, cleaned
and put back into their body while they are
By BARBARA
METCALFE
Washing machinefor blood that
turns you into
your own donor
still on the operating table.
This cuts the risk of infections
and reactions and conserves
valuable blood stocks. it also
speeds up recovery time — the
months of adjustment required
after a transplant from another
source are not necessary here,
since it is a patient’s own blood.
Blood washing has been available
for the past 20 years, but the initial
outlay on equipment and a lack of
staff trained in the technique have
stopped it being used as widely as
it might.
now, anaesthetists say this
must change. Guidance published
last year by the Association
of Anaesthetists said that all
nHS hospitals performing major
surgery should use cell salvage
for operations likely to cause
significant blood loss.
The guidelines, detailed in the
journal Anaesthesia, state that
cell salvage is a ‘relatively simple
and effective blood conservation
technique’ and should be ‘integral
to surgical practice’.
Dr Andrew Klein, a consultant
anaesthetist from the Royal
Papworth Hospital in cambridge,
chaired the group that devised
the new guidance after examining
recent trials of the technology.
He explains the process: ‘Blood
is sucked from a wound, put into a
canister, then mixed with heparin
to stop clotting. Once a pint or so
is collected, the blood is quickly
spun in a centrifuge, so that onlythe red cells are collected, and the
rest — plasma and debris such as
fat and bone — is washed away
with saline. The red cells are kept
in a bag, ready to be infused back
into the patient via their drip.’W
HeTHeR a normal
transfusion or one via
cell salvage, only red
cells — which ferry
vital oxygen around the body —
are ever transfused into a patient.
‘if you lose too much blood,
and therefore too many red cells,
during surgery, you could end up
not having enough to carry oxygen
around,’ says Dr Klein. ‘it couldlead to anaemia and even death
if there is not enough oxygen to
reach vital organs.
‘Problems can arise if you have
to wash a lot of blood. You have
around ten pints of blood in your
body and, if you lose more than
half into a cell salvage machine,
for example, then you are losing a
lot of plasma.
‘We test the blood throughout
the operation to make sure it’s
OK and to find out whether we
need to infuse more plasma or
platelets from the blood bank.’
Plasma carries salts and enzymes
and transports nutrients, proteins
and hormones to the parts of
the body that need them. it is
also vital for blood clotting.not all operations lead to
enough blood loss for the cell
salvage machine to be of use. But
cell salvage should be routinely
used in hip replacements and
revisions, caesareans, spinal
surgery, cardiac procedures and
other operations where the loss
of more than a pint of blood is
expected, says the Association
of Anaesthetists.
While some 90 per cent of trusts
are thought to have blood-washing
equipment, not all have trained
staff to use it, often due to training
costs and staff shortages.
However, with a unit from a
blood bank costing up to £150,
plus administration and delivery
fees, donated blood is expensive.
Blood washing can be cheaper
in the long term, but the £20,000
i^ nitial outlay for the salvage
machine has put some off, while
the £100 charge per patient for
the disposable equipment used
in the procedure has left others
reluctant to use the technology —
even if they have the machine.
James cook University Hospital
in Middlesbrough has embraced
cell salvage. its seven machines
are used every weekday and on
many weekends in its 27 theatres.
‘We use cell salvage machines
20 to 25 times per week — and
sometimes more,’ says chris
elliott, a transfusion scientist
at South Tees Hospitals nHS
Foundation Trust. ‘As a proportion
of transfusions, cell salvage blood
represents just 2 to 3 per cent.
‘The majority of surgical cases
do not bleed sufficiently in theatre
to allow blood to be salvaged.’
Despite cell salvage being used in
a relatively low proportion of cases,
the savings are huge.
Over the past decade, it has
saved James cook University
Hospital more than £3 million — a
healthy return for what could be
seen as just a wash and spin.