Recent research in spinal surgery has demonstrated that employing autologous blood in patient blood management significantly reduces the need for allogeneic blood transfusions. Typically, intraoperative cell salvage (ICS) necessitates a minimum amount of blood loss to generate a transfusable unit. However, the introduction of the innovative HemoClear autologous blood filter has made this requirement obsolete. This new method does not demand a minimum blood volume and additionally produces high quality transfusable platelet-rich autologous red blood cells (PRBC’s), enhancing its utility in clinical settings.

1. Minimizing blood loss and transfusion risks in spinal surgery
Since the 1990s, the frequency of spinal surgeries has increased by over 200%, particularly revision surgeries aimed at correcting deformities. These procedures are frequently associated with considerable blood loss and subsequently high rates of postoperative transfusions. Retrospective studies have linked postoperative donor blood transfusions to higher perioperative mortality, complication rates, and healthcare costs. Given these risks, it is crucial to adopt strategies that reduce intraoperative blood loss and minimize donor blood transfusions.

2. Preoperative strategies to minimize blood loss and avoid transfusions
Every effort should be directed towards minimizing blood loss and avoiding transfusions, with a suggested hemoglobin threshold of 7-8 g/dL unless the patient is symptomatic. Preoperative measures include patient counseling and the discontinuation of anticoagulants based on the drug’s elimination half-life. The cessation of aspirin and other NSAIDs at least one week before surgery is commonly advised, although the evidence supporting this is variable.

3. Intraoperative strategies to minimize blood loss and avoid transfusions
Intraoperatively, strategies to reduce blood loss include optimal positioning to decrease intraabdominal pressure and maintaining normothermia. The use of tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents such as oxidized regenerated cellulose, microfibrillar collagen, gelatin sponges, and flowable agents is highly recommended in cases with large surgical exposures and expected significant blood loss. Hypotensive anesthesia is another technique to lower blood loss, though it should be used cautiously to prevent ischemic neural injury, particularly maintaining mean arterial pressure (MAP) above 80 mm Hg during neural manipulation to prevent neuromonitoring abnormalities. Additionally, cell salvage techniques are advised for those with high estimated blood loss where allogeneic transfusion is not feasible, such as in patients with specific beliefs or rare blood types.

4. Intraoperative Cell Salvage
Intraoperative Cell Salvage (ICS) is crucial for reducing blood loss during spine surgery. ICS collects, wash and process blood from the surgical site, producing autologous RBC-units for reinfusion. This technique is significantly decreasing the need for allogeneic blood transfusions. For example, a recent scoliosis surgery study showed a reduction in allogeneic transfusion rates to 6% with ICS, compared to 55% without it. However, the traditional ICS centrifugal technique requires a minimum blood loss volume to be effective.

5. Mitigating coagulopathy risks in spine surgery
Several studies have reported instances of coagulopathy linked to the use of traditional centrifugal Intraoperative Cell Salvage (ICS). Key issues identified include the transfusion of heparinized blood back to the patient, the centrifugal process which eliminates all platelets and clotting factors, and the activation of coagulation triggered by mediators released from platelets. Recent literature highlights that the levels of heparin in transfused blood are minimal in contemporary cell salvage systems. Furthermore, while it is beneficial to closely monitor platelet functionality, evidence suggests that there is a margin of safety regarding the elimination of platelets and maintaining coagulation functionality. This underscores the importance of vigilant oversight in managing platelet activities and coagulation processes when utilizing ICS in surgical settings.


HemoClear - Innovating Blood Transfusion Solutions

The introduction of the HemoClear innovative micro-filtration technology in cell salvage marks a pivotal advancement in the field of blood transfusion during spinal surgery. This cutting-edge filter technology simplifies the process by eliminating the need for additional equipment or electricity, thereby enabling any healthcare professional to operate it with ease. Importantly, it does not require a minimum volume of blood to function, which allows it to become a standard feature in spinal surgery procedures. The technology's reliance on gravity, rather than centrifugal forces, ensures that platelets are captured from the shed blood in a non-activated state, enhancing patient recovery. Additionally, the inclusion of a washing procedure in the micro-filtration system provides quality transfusion blood that rivals the traditional centrifugal methods. Together, these features not only streamline the operational aspects of autologous blood transfusion but also significantly improve the quality of care, positioning this technology as a transformative tool in spinal surgical practices.