Tuesday, February 16, 2016

Cell Saver Saving More than Cells

Peri-operative cell salvaging is a technique used during surgery when the estimated blood loss is expected to be significant.  When people are in situations that leave them presenting with blood loss, the health care providers must know the person's blood type.  Prior to any surgery, the hospital would have this on file given the presenting risks. Up until about 30 years ago, the only way to replace lost blood was by administering blood from another human donor.  Of course, any blood that must be given this way nowadays is closely monitored for bacteria and viruses, but there are still many, many different types of life-threatening reactions that can present to a patient regarding different antibodies in the blood, etc.

Since "most fatal transfusions result from human error," one can see how the intra-operative cell salvaging process greatly minimizes any amount of human error possible - there is no way the blood is the wrong type or has the wrong Rh factor!  Using the patient's own blood to infuse back into their body seems like a simple idea, but really is an intricate process.  In surgery, witnessing this type of blood collection and infusion, it appears that blood is suctioned out of the surgical incision, and collected in an IV bag for later infusion.  This detailed process must account for many different details of blood and surgery.  The suctioning of blood in the surgical cavity must be coated with an anticoagulant, to prevent the blood from clotting during the suctioning and filtering process.  The red blood cells are separated from plasma during centrifugation.  Typically, the plasma is removed and saline is mixed with the red blood cells to "wash" the blood; "washing the blood removes anticoagulation, plasma-free hemoglobin, and plasma proteins, including activated clotting factors and platelets."

This small but momentous invention has greatly improved outcomes of major invasive surgeries.  Though there is no such thing as eliminating human error, this process, when completed within the surgical suite, does completely eliminate the possibility of ABO (blood typing) incompatibility.  In fact, the possibility of bacteria contaminating the blood is the only perceived threat to this autologous blood donation (and is a minimal threat itself).  Through evidenced-based practice, this process of intra-operative cell salvaging has proven itself to be an innovative, yet obviously simple solution to blood loss.

Unfortunately in health care, and often times in life in general, there must be a presenting problem before people begin to contemplate preventative measures that could prevent similar issues in the future.  It was not until so many blood transfusion reactions occurred, that people really began thinking outside of the box on how to lessen the occurrence of this type of issue.  In this way, I am reminded of Gandhi compared to hospital-insurance provider relationships.  In the past, when a person had the wrong blood infused, due in part to some sort of human error, the insurance providers paid for treatment the patient received.  As time went on, the insurance companies started reevaluating what their clients were in the hospital for and decided they should not help pay for any treatment the patient received in relation to a complication they technically should not have experienced (if the hospital was doing everything correctly).  Now, generally, a hospital pays out-of-pocket for any complications that arise that were caused by hospital error.

Gandhi was a man who saw injustice, like the insurance companies covering treatment for complications their customers should technically have never acquired.  Gandhi utilized peaceful political techniques to advocate for change; Gandhi's refusal to eat mirrors the insurance companies's refusal to pay for hospital-acquired complications. In more ways than one, noticing that the cell salvaging solution came about because too many people were losing blood and there was too great a risk of transfusion reactions, reminds me of Gandhi's style of implementing change.  Gandhi implemented protest on a personal level, denying himself food in order to take a political stance.  Insurance companies are more selfish, saving themselves money, yet still peacefully protesting hospital acquired infections and the like.  It is almost that these simple, yet great, ideas have the inability to generate in a proactive way, but are both peaceful reactions to an inexcusable reality that effectively implement change for the better.





  1. You made a really innovative connection of the insurance companies with that of Gandhi's principles. When reading through your post, I did not initially see the connection but it all came together at the end. Blood transfusions, although considered common amongst treatments, is still fatal. Modern technology has improved to the point where one can transfuse their own blood to themselves. Aside from the technological advances, it makes me think of the cost that comes with actually using these technologies. Can a common man afford it? I cannot agree more on what you said about the insurance companies limiting coverage on complications from medical errors that they should not have received in the first place. My personal experience with insurance companies happened when I shadowed a physician last summer. The physician needed the insurance companies to sanction an oncology medication for a patient dying of a special type of cancer. However, the insurance company not only denied his request but also spoke to the physician with absolutely no respect. The physician had to remind the insurance company of this high position in the hospital, along with the large various consequences the patient and the patient's family will have to face because of the insurance company's choice. To clarify, the insurance company had recently decided to cut down on that certain medication since they thought other physicians were overusing it. It was also because the insurance companies were not making a large profit with that medication. In this case, the medication was genuinely required. Seeing this situation happen in front me showed me that really goes on in medical field and the injustice that is faced by both the patient and the physician. It made me think of other patients that just cannot afford the treatment as well. The medical field has then close its door on the patients that cannot afford to get good insurance; thus, it creates an inequality among the social classes. I really enjoyed your post, and it made me think of the medical technologies in a different way.

  2. Would be interesting to know more about the people who actually developed this technology and what their motivations were.


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