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Lipid / Leucocyte

Reinfusion Filter for


Salvaged Blood

Questions &
Answers Booklet
GENERAL

Q1. What are the clinical problems associated with


contaminants in salvaged blood?
■ Impaired lung function and reperfusion injury
■ Adult Respiratory Distress Syndrome (ARDS)
■ Brain Injury and Fat Embolic Syndrome (FES) - Lipid
■ Lung dysfunction - Microaggregates and surgical debris

Q2. Do you have any clinical data to support reinfusion


of post-operative shed blood?
A review of 87 papers by Munoz Gomez et al 1
concluded that “…salvaged filtered blood is a source of
red blood cells of sufficient quality to be safely reinfused
and that their reinfusion contributes significantly to
reduce the need for homologous blood.”
The American Association of Blood Banks (AABB) state
that “The collected blood can be processed with or without
cell washing, but must be filtered before reinfusion”.2,3

Q3. Are all filters the same?


There is a wide variation in filter types. The choice will
depend on the particular application and the level of
protection desired. Advice should be sought from the
manufacturer. Ideally for salvaged blood a filter with
enhanced lipid and leucocyte removal capabilities is
required to minimise subsequent clinical sequelae.

Q4. How does the Lipid/Leucocyte filter differ from


a standard screen filter?
The Lipid/Leucocyte incorporates a clinically proven 40 µm
screen filter for reduction of microaggregates and debris.
However, it also has additional media which typically
removes 84% of lipids and 71% of leucocytes.

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PRACTICAL ISSUES

Q5. What is the filter volume?


Approximately 20 ml

Q6. Why do we need to remove air in the bag when


priming the Lipid/Leucocyte filter? Can't you just
hang the bag up and run it through?
By removing as much air as possible this ensures that
the maximum filtration area is being used to reduce the
contaminants in the blood.

Q7. Does air affect the Lipid/Leucocyte filter i.e.


the air you need to remove from the bag,
before priming the filter?
If too much air is contained in the Lipid/Leucocyte filter
this can result in a reduced flow-rate or even blockage
of the device.

Q8. Does it matter if the entire Lipid/Leucocyte filter


is not quite primed when starting reinfusion?
A small volume (e.g. 1-2 ml) of air at the top of the
Lipid/Leucocyte filter housing should not cause any
problems. It is essential, however, to ensure that the
media is completely wetted as this gives optimal air
removal and filtration performance.

Q9. Does the line need priming with saline?


If you prime with saline how do you prime the
Lipid/Leucocyte filter?
The line does not need to be primed with saline, but if
this is your preferred practice then just replace the saline
bag with the blood bag ensuring as little air as possible is
transferred into the Lipid/Leucocyte filter.

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Q10. If the Lipid/Leucocyte filter is washed out with
saline at the end of use can you use it again?
What are the hazards of doing this?
The filter should not be re-used after indicated use. Also,
we do not recommend flushing the Lipid/Leucocyte filter
with saline as this may affect the binding capability of the
additional media in the filter. This could potentially result
in flushing retained contaminants from the filter.

Q11. How do I achieve a good prime?


The best way to prime the filter is to invert it after
spiking the blood unit. Loosen the administration set cap
(unless it is vented) and maintain an even pressure on
the bag before opening any clamps downstream of the
filter. Pressure should be evenly maintained until the
administration set is primed and the downstream clamps
closed. The blood unit can now be positioned on the
drip stand and the filter should be completely primed.

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LEUCOCYTES

Q12. What is a neutrophil?


This is the most abundant phagocytic leucocyte
i.e. it engulfs foreign debris and cells and can be
very aggressive.

Q13. What happens when a neutrophil is activated?


Cell salvaged blood contains numerous leucocytes of
which the neutrophils are in an activated state4.
They release reactive oxygen species, proteolytic enzyme
and lipid mediators. This can cause reperfusion injury.

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LIPID

Q14. Where does the lipid in salvaged blood come from?


■ Subcutaneous fat released from connective
tissue when cutting the skin
■ Bone marrow6 from when bones are cut or reamed7
■ Blood i.e. diet related

Q15. What symptoms are seen with Fat


Embolic Syndrome?
The patient must display 2 out of 3 major symptoms9,10.
■ Pulmonary distress
■ Mental disturbances
■ Petechial rash

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MICROAGGREGATE DEBRIS

Q16. What are microaggregates?


The clotting and coagulation cascades are stimulated
during the loss of blood at the wound site during
collection and handling of salvaged blood.
This induces the formation of microaggregates
composed of activated platelets, leucocytes and fibrin.
Additionally bone fragments, skin, cement and other
debris may be present in salvaged blood.

Q17. What are the clinical implications of


these contaminants?
If the blood is not adequately filtered then these debris
are capable of blocking capillaries thus affecting organ
function. The arterioles in the lungs are the body’s
natural filters and if these become blocked then this can
result in Adult Respiratory Distress Syndrome.

Q18. What is Adult Respiratory Distress


Syndrome (ARDS)?
This is a condition of diffuse pulmonary infiltrates,
refractory hypoxaemia and respiratory distress 15,16.
The patient requires ventilation and X-rays show
characteristic changes. In summary, the lung is unable
to function properly to oxygenate the blood before
passing to the heart.

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11. Blevins FT, Shaw B, Valeri CR, Kasser J, Hall J. Reinfusion of
shed blood after orthopaedic procedures in children and
adolescents. J Bone Joint Surg Am.
1993; 75(3):363-71.
12. Clements A, Mulholland J, Pope N. Scanning electron
microscopy of a lipid filter after use with washed
salvaged blood. Therapeutic Filtration and Extracorporeal
Circulation Conference (TFECC) 2003.
13. Fox MA. Filtration of shed mediastinal blood. Perfusion.
1993; 8:331-6.
14. Chapman, MJ. Adult respiratory distress syndrome -
an update [Web Page]. Available at http://www.nda.ox.ac.
uk/wfsa/dl/html/reviews/rev003.htm.
(Accessed 13 November 2003).
15. Petty TL, Ashbaugh DG. The adult respiratory distress
syndrome. Chest. 1971; 60(3):233-9.

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REFERENCES
1. Munoz Gomez M, Garcia Vallejo J, Lopez-Andrade
Jurado A, Gomez Luque A, Ruiz Romero De La Cruz
M, Maldonado Eloy-Garcia J. Autotransfusion after
orthopedic surgery. Analysis of quality, safety and efficacy
of salvaged shed blood. Rev Esp Anestesiol Reanim.
2001; 48(3 ):131-40.
2. American Association of Blood Banks (AABB). Blood
Transfusion Therapy: A Physicians's Handbook. 7th
edition. American Association of Blood Banks (AABB),
2002. (Triulzi D ).
3. Standards for perioperative autologous blood collection
and administration. 1st edition. Bethesda, M.D.:American
Association of Blood Banks, 2001. (Santrach PJ ).
4. Pertilla J, Leino L, Poyhonen M, Salo M. Leucocyte content
in blood processed by autotransfusion devices during
open-heart surgery. Acta Anesth Scand. 1995; 39:443-8.
5. Henn-Beilharz A KC . Retransfusion in bone surgery: what
happens to the fat? Anasthesiol Intensivmed Notfallmed
Schmerzther. 1991; 26(4):224-5.
6. Henn-Beilharz A, Hoffmann R, Hempel V, Brautigam KH.
The origin of non-emulsified fat during autotransfusions
in elective hip surgery. Anaesthesist. 1990; 39(2):88-95.
7. Brooker RF, Brown WR, Moody DM et al. Cardiotomy
suction: A major source of brain lipid emboli during
cardiopulmonary bypass. Ann Thorac Surg. 1998;
65:1651-5
8. Johnson MJ, Lucas GL. Fat embolism syndrome.
Orthopedics. 1996; 19(1):41-8.
9. Gossling HR, Donohue TA. The fat embolism syndrome.
JAMA. 1979; 241(25):2740-2.
10. Barnett M. The origins, clinical significance and visual
perception of particulate matter. American Society for
Parenteral and Enteral Nutrition (ASPEN) 20th Clinical
Congress. 178-82.

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Unomedical a/s
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DK-3450 Alleroed
Denmark

Phone: +45 48 16 70 00
Telefax: +45 48 10 30 00
www.unomedical.com

The information provided in this literature was reviewed for accuracy at the time of publication. Product
data may be subject to change without notice. For current information consult your local Pall distributor
or contact Pall directly. Part numbers quoted above are protected by the Copyright of Pall Europe Ltd.

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©2003, Pall Europe Limited.
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Printed in England. PMED/0.1M/DBD/4.2004