The Journal of Bone and Joint Surgery, Vol 75, Issue 3 363-371, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Reinfusion of shed blood after orthopaedic procedures in children and adolescents
FT Blevins, B Shaw, CR Valeri, J Kasser and J Hall
Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
A prospective study was done of the results of infusion of drained blood
after major procedures on the spine and hip in twenty-six patients. The
Solcotrans system was used to salvage drained blood in the first six hours
after the operation. Transfusion requirements, blood loss, hematocrit,
temperature, prothrombin time, partial prothrombin time, platelet count,
results of blood cultures, and levels of factor VIII, factor V,D-dimer,
antithrombin III, plasminogen, protein C, and complement C3a des arginine
were determined for some or all of the patients. A mean of 375 milliliters
of blood from the Solcotrans receptacle was reinfused. All of the cultures
were negative. There were no febrile reactions. The mean values for the
specimens of the salvaged blood were: hematocrit, 0.20; hemoglobin,
seventy-one grams per liter; plasma hemoglobin, 2.36 grams per liter; C3a
des arginine, 9.4 x 10(-3) grams per liter; fat particles of less than nine
micrometers in diameter, 23,643 per milliliter; and D-dimer, 205 x 10(-3)
grams per liter. Studies of blood samples that were collected from patients
one to two hours and twelve to eighteen hours after the transfusion showed
only slight increases in fibrin split products one hour after the
transfusion; these values reverted to normal by eighteen hours. No clinical
coagulopathy associated with reinfusion was observed. The reinfusion of
unwashed, filtered shed blood that was as much as 15 per cent of the total
blood volume proved to be a safe technique after major orthopaedic
procedures.
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