Is there literature to support the use of the cell saver for washing blood prior to administration of "old blood?"
The discussion of washing stored, allogeneic blood is an old one that is frequently discussed amongst perfusionists. To my knowledge, there is no research to support or counter this practice. From a theoretical perspective, there is some interesting work arising from the lab of Dr. Mark Gladwin, who is the Chief of Pulmonary Medicine, at the University of Pittsburgh. Mark noticed that sickle cell patients who had high levels of cell free hemoglobin had high levels of pulmonary and systemic hypertension. This discovery has evolved to him assessing free hemoglobin which is found in allogeneic blood. Cell free hemoglobin is a scavenger of nitric oxide. Nitric oxide (NO) is responsible for vasodilation of the microcirculation. So, if cell free hemoglobin is scavenging NO, then the microcirculation may be vasoconstricted resulting in decreases in tissue oxygen tension. This is exactly opposite of our goal of enhancing tissue oxygenation with a blood transfusion. So, from this theoretical perspective, there may be some value in washing, old stored cells in order to minimize the infusion of cell free hemoglobin. This being said, cell free hemoglobin is only one of several important components of the red cell storage defect.
Jonathan Waters, MD