Autologous blood transfusion and intraoperative cell salvage in a patient with homozygous sickle cell disease

BACKGROUND Autologous transfusion can eliminate the need for homologous transfusions. In addition, hypotensive anesthesia and devices that salvage red blood cells for return to the patient can reduce operative blood loss. However, blood from patients with sickle cell disease is difficult to store.

SUMMARY A 16-year-old black girl with homozygous sickle cell disease needed surgery for progressive scoliosis. Her family’s religious convictions precluded homologous transfusions. During surgery, 400 mL of autologous blood that had been successfully stored was transfused, as was 800 mL of blood salvaged using a cell-saving device, and 3800 mL of nonblood plasma expanders. Intravenous agents were used to maintain hypotension. However, following a rise in the patient’s prothrombin and thromboplastin times, four units of homologous packed red cells were transfused with the permission of the patient’s parents.

CONCLUSIONS Patients with sickle cell disease can be given hypotensive anesthesia and autologous transfusions of blood donated before surgery and blood salvaged during surgery using a cell-saving device.