CS in HbS

 Q: What is the caveat of using Cell Saver (CS) in patients with sickle cell disease and sickle cell trait (HbS)? 

Answer:  Cell saver use in patients with sickle cell disease or trait may cause harm. The washing process during CS may cause hemolysis or sickling of red blood cells with HbS. 

By default "Sickled RBCs" are prothrombotic. Dehydration, hypotension, acidosis, low cardiac index, hyperthermia, post-op shivering are major risk factors in these patients. 

In elective surgery, preoperative optimization is the best strategy. African-American patients have a higher rate of sickle cell disease and should be particularly managed. In high risk patients, hemoglobin electrophoresis should be strongly considered prior to surgery. To avoid delay in blood products during surgery, type and cross with presence/absence of antibodies (from previous transfusions) should be established. During surgery adequate hydration is of paramount importance. . 

In cardiac surgery centrifugal cardio-pulmonary-bypass (CPB) pump is preferred.

#surgical-critical-care

#hematology

References:

1. Chabot D, Sutton R. Mitral valve replacement in a patient with sickle cell disease using perioperative exchange transfusion. J Extra Corpor Technol 2008; 40:275. 

2. You D, Peiro-Garcia A, Ferri-de-Barros F, Parsons D. Hemolysis Following Intraoperative Cell Salvage Replacement in a Scoliosis Patient With Sickle Cell Trait: A Case Report. Spine (Phila Pa 1976) 2017; 42:E1331. 

3. Okunuga A, Skelton VA. Use of cell salvage in patients with sickle cell trait. Int J Obstet Anesth. 2009;18(1):90-91. doi:10.1016/j.ijoa.2008.06.010