PIG Meeting: 11th February 2021
85yo male for THR
- Mantle cell lymphoma – in remission
- Mild anaemia Hb 122
- Can his anaemia be optimised?
- Discussed with haematologist – didn’t feel EPO was indicated
- Fe replete
- Should we use cell salvage?
- Blood transfusion after primary THR is not uncommon (although usually occurs postoperatively)
- Lymphoma is not a contraindication. See the HNE cell salvage guideline.
- Info from one of the cell salvage coordinators:
- “Closed circuits” for JW patients just means than the return bag is connected from the start by an infusion line to the patient.
- Newer systems have a smaller collection bowl but still need to be filled. The circuit is flushed with saline to collect any red cells stuck in the filter and saline-soaked bloodied packs can also contribute to collection. There is still a minimum volume but this is small with an end-product of 135ml of 70% Hct red cells.
- Disadvantages include the environmental costs of the circuit + staffing and resource allocation (outweighed by the benefits in a patient who declines allogeneic transfusion)
- Which surgical cases warrant cell salvage in a JW patient?
- Difficult to be specific, each case needs to be considered individually.
- In general, cases which would normally warrant a G&S (and thus have a likely higher risk for transfusion), should likely have cell salvage, although this is not a hard rule and may need to be discussed with the surgeon.