TXA and CS

Q: If topical or intravenous tranexamic acid is used in the surgery, the cell salvage technique (CS = cell-saver) should never be applied.

A) True

B) False

Answer: B

Meticulous care should be taken while obtaining cell-saver and transfusing back to patients. Salvaged blood should never be used when solutions may be in contact with potentially harmful contents such as antibiotic irrigation, hydrogen peroxide, alcohol, or povidone-iodine solutions. Also, CS should never be transfused with hypotonic fluids like sterile water, which may lead to hemolysis. The same rule is applied to admixture with hemostatic products or bone cement, which includes topical thrombin, fibrin glue, and microfibrillar bovine collagen-based products. 

Topical or intravenous tranexamic acid is considered safe and can be used along with CS.

#hematology

#surgical-critical-care

References:

1. Waters JH. Intraoperative blood recovery. ASAIO J 2013; 59:11.

2. Esper SA, Waters JH. Intra-operative cell salvage: a fresh look at the indications and contraindications. Blood Transfus 2011; 9:139.

3. Murphy GJ, Mango E, Lucchetti V, Battaglia F, Catapano D, Rogers CA, Angelini GD. A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2006 Sep;132(3):475-80, 480.e1-8. doi: 10.1016/j.jtcvs.2006.01.064. PMID: 16935098.