Fragility of Red Blood Cells Collected Under Different Conditions With a Cell Saver Device

Objective To quantify the degree of lethal and sublethal damage to red blood cells (RBCs) by cell saver (CS) processing among different conditions of shed blood in cardiac surgery. Design Prospective randomized, double-blinded, controlled study. Setting Single university hospital. Participants Twenty rabbits were divided randomly into non-heparinized and heparinized groups. Thereafter, each group was subdivided into non-gauze and gauze groups based on whether the blood was collected with gauze and squeezed out. Interventions Blood from each group was aspirated directly from the heart and underwent CS processing. Mechanical fragility index (MFI) and percent hemolysis were measured pre- and post-CS processing. Measurements and Main Results In RBCs after CS processing, the MFI and percent hemolysis were increased significantly in both the non-heparinized and heparinized groups compared to pre-CS processing. The MFI was significantly higher in the heparinized group than in the non-heparinized group (p = 0.002). However, no differences in percent hemolysis were detected between groups (p = 0.696). The MFI and percent hemolysis of the non-gauze and gauze groups did not differ. Conclusion This study reports the increase in sublethal and lethal injuries to RBCs from heparinized and non-heparinized blood after CS processing. CS-processed heparinized blood contained more sublethally injured RBCs compared to CS-processed non-heparinized blood. RBCs collected by squeezing blood-saturated gauze did not exhibit additional trauma. Further investigation is required to determine the clinical implications of transfusing rescued but injured RBCs using a CS.