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Letters to the Editor: Letters & Announcements

Quality Oversight Needed for Intraoperative Autologous Blood Recovery and Readministration

Sloan, Tod B. MD, MBA, PhD; Myers, Greg MD; Janik, Daniel J. MD; Burger, Evalina M. MD; Patel, Vikas V. MD; Jameson, Leslie C. MD

Author Information
doi: 10.1213/ANE.0b013e3181b9eb73

In Response:

We agree with Dr. Waters that standards for intraoperative autologous transfusion (IAT) would be helpful.1 In our cases, we believe that the hemolysis was the result of trauma as the blood was collected by “skimming” from the bony surface of the spinal surgery site despite suction pressures in the recommended range.2 What was disappointing in these cases was the lack of warning that the blood was hemolyzed before transfusion and that such a small amount of transfusate (Case 1) could have hemodynamic consequences and contribute to a coagulopathy. We also did not appreciate that free hemoglobin is normally not completely removed in the IAT machine centrifugation process. The IAT units appeared to be of normal color, and hemolysis in the serum was not apparent until centrifugation or after the cells had been allowed to settle. We reviewed the fluids used and they were saline; the effluent wash appeared appropriately clear, and no other deviations from standard practice were present. Furthermore, the IAT machine and the disposables used were later checked and all were within the manufacturer’s quality standards. This machine had been used on a large number of cases before these cases and afterward without identified problems. Our IAT technologist is certified, and the IAT service undergoes regular Quality Assurance assessment, which reinforces our focus on the unusual and unexpected events in these cases. This lack of warning has increased our respect for the potential problems; we definitely are now not complacent about using IAT blood and actively watch for signs of hematuria and coagulation abnormalities. We agree that anything reducing the likelihood of a recurrence of these events or providing a warning when blood in an IAT unit might be hemolyzed would improve patient safety. In these cases, we did not appreciate a purple color or transparency mentioned by Dr. Waters. We believe that these cases support the recommendation for standards raised by Dr. Waters.

Tod B. Sloan, MD, MBA, PhD

Greg Myers, MD

Daniel J. Janik, MD

Department of Anesthesiology

University of Colorado Denver

Aurora, Colorado

tod.sloan@ucdenver.edu

Evalina M. Burger, MD

Vikas V. Patel, MD

Department Orthopedics

University of Colorado Denver

Aurora, Colorado

Leslie C. Jameson, MD

Department of Anesthesiology

University of Colorado Denver

Aurora, Colorado

REFERENCES

1. Waters JH. Quality oversight needed for intraoperative autologous blood recovery and readministration. Anesth Analg 2009;109:1706
2. Sloan TB, Myers G, Janik DJ, Burger EM, Patel VV, Jameson LC. Intraoperative autologous transfusion of hemolyzed blood. Anesth Analg 2009;109:38–42
© 2009 International Anesthesia Research Society