Decreasing homologous blood transfusion in spinal surgery by use of the cell saver and predeposited blood.

Blood loss and blood replacement are necessities in spinal surgery. They also have increasing risks. Three blood replacement options and combinations were investigated in patients undergoing major spinal deformity surgery. In Section 1, intraoperative replacement from harvested cell saver blood was investigated in 35 patients. This group averaged 40% (20-60%) return of the red cell mass lost intraoperatively. In Section 2, intraoperative replacement via predeposited autologous blood was investigated in 41 patients. The predeposited blood replaced 64% of the intraoperative red cell mass lost. In Section 3, ten single-stage and ten two-stage spinal surgery cases using both cell saver and autologous predeposited blood were investigated. With this program, 90% of the single-stage patients did not require additional homologous blood, while 80% of the two-stage patients did. In Section 4, 65 patients undergoing six general types of spinal surgery were examined to determine the number of predeposited autologous units needed to avoid homologous blood during hospitalization. Guidelines for determining optimal donation were developed assuming the use of intraoperative cell saver use.