Original Article

Intraoperative Cell Saving: Is the Solution the Actual Problem?

^* Department of Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
^† Department of Cardiovascular Perfusion, Division of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and ^‡ National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa

Address correspondence to: Krishnan Pillay, MHSc, Department of Cardiovascular Perfusion, Division of Cardiothoracic Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road, Cato Manor, Durban 4091, South Africa. E-mail: krishnanpil@gmail.com

Received: 29 August 2020
Accepted: 28 January 2021

Abstract

Allogenic blood is a scarce, precious, and expensive resource that is not always available on demand. After termination of cardiopulmonary bypass, a large amount of residual pump blood remains in the extracorporeal circuit. The cell saver washes and concentrates this blood with .9% normal saline (NS), making autologous blood available and reducing the demand for allogenic blood. To quantify the quality of residual pump blood it was washed with either NS or a bicarbonate-buffered solution (Balsol). A qualitative in vitro analysis was conducted. Residual cardiopulmonary bypass blood from forty bypass circuits was processed with a cell saver device, using NS or Balsol solution. Measurements made compared the pH, electrolytes, metabolites, hematocrit, hemoglobin, osmolality, albumin, total protein, and strong ion difference. There were significant differences between the NS and Balsol groups. In the Balsol group, osmolality, electrolytes, and strong ion difference were similar to the constitution of Balsol solution after washing, but not with the normal saline group. Washing residual cardiopulmonary bypass pump blood with Balsol solution results in a resuspended red cell concentrate with a superior electrolyte profile and a strong ion difference similar to that of residual pump blood.