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Erythrocyte Viability in Blood Salvaged During Total Joint Arthroplasty with Cement

Investigation performed at the Scripps Clinic, La Jolla, California

Clifford W. Colwell Jr., MD
Ernest Beutler, MD
Carol West
Mary E. Hardwick, RN, MSN
Beverly A. Morris, RN, CNP
Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037. E-mail address for C.W. Colwell Jr.: colwell{at}scripps.edu

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was The Scholl Foundation.

Background: Erythrocyte salvage, the collection of a patient’s blood shed from the surgical wound, is one aspect of blood management. Previous investigators have examined salvaged blood for content; however, to our knowledge, none have examined the viability of erythrocytes after exposure to the chemical and thermal reactions produced by motorized instruments and polymethylmethacrylate during surgery. The purpose of this study was to determine the viability of salvaged erythrocytes from patients undergoing primary total joint arthroplasty with cement.

Methods: Erythrocyte viability studies were performed on specimens from three subjects with use of a double isotope-labeling technique employing chromium-51 and technetium-99m. With use of a fresh blood specimen obtained prior to surgery and a specimen of salvaged blood that had been recycled, washed, and filtered with use of the Cell Saver, the viability of the Cell-Saver-processed erythrocytes, labeled with chromium-51, was calculated on the basis of the technetium-99m-labeled red blood-cell mass.

Results: The mean erythrocyte viability (and standard deviation) in blood salvaged with use of the Cell Saver was 88.0% ± 3.8%. The standard of the American Association of Blood Banks for minimum erythrocyte viability in adequately cross-matched allogeneic blood or predeposited autologous blood is 70%.

Conclusions: The high rate of viability of the erythrocytes in this study shows that the Cell Saver is a valuable adjunct to other blood management techniques for patients having total joint arthroplasty. We believe that the very high mean rate of erythrocyte viability and the extremely small standard deviation in our three subjects, as compared with the standards of the American Association of Blood Banks, made additional study subjects unnecessary.

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