INTRODUCTIONIntraoperative cell salvage (ICS) is an important aspect of patient blood management programmes. An ICS service was introduced at KK Women's and Children's Hospital, Singapore, from 2 May 2011 to 30 April 2013 to aid in the management of massive obstetric haemorrhage.

METHODSWith support from the Ministry of Health's Healthcare Quality Improvement and Innovation Fund, a workgroup comprising obstetricians, anaesthetists and nursing staff was formed to develop training requirements, clinical guidelines and protocols for implementing ICS using the Haemonetics Cell Saver 5. Pregnant women with an anticipated blood loss of > 1,000 mL during Caesarean delivery, a baseline haemoglobin level of < 10 g/dL, rare blood types and who had refused donor blood were recruited to the service after obtaining informed consent.

RESULTSA total of 11 women were recruited to the ICS service; the primary indications were placenta praevia and placenta accreta. Median blood loss in these 11 patients was 1,500 (range 400-3,000) mL. In four patients, adequate autologous blood was collected to initiate processing and salvaged, processed blood was successfully reinfused (mean 381.3 [range 223.0-700.0] mL). Median blood loss among these four patients was 2,000 (range 2,000-3,000) mL. No adverse event occurred following autologous transfusion. Mean immediate postoperative haemoglobin level was 8.0 (range 7.1-9.4) g/dL.

CONCLUSIONThe implementation of an obstetric ICS service in our institution was successful. Future studies should seek to address the cost-effectiveness of ICS in reducing allogeneic blood utilisation.

Blood Preservation ; Blood Transfusion, Autologous ; methods ; standards ; Cost-Benefit Analysis ; Female ; Hemoglobins ; analysis ; Hemorrhage ; therapy ; Humans ; Obstetrics ; methods ; standards ; Operative Blood Salvage ; methods ; standards ; Placenta Accreta ; therapy ; Placenta Previa ; therapy ; Practice Guidelines as Topic ; Pregnancy ; Program Development ; Program Evaluation ; Singapore ; Tertiary Care Centers

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.
Cryopreservation ; Estradiol/blood ; Female ; Fertility Preservation/*methods ; Fertilization in Vitro ; Humans ; Infertility, Female/surgery ; Neoplasms ; Nitriles/therapeutic use ; Oocyte Retrieval/*methods ; Ovulation Induction/*methods ; Retrospective Studies ; Triazoles/therapeutic use

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.
Cryopreservation ; Estradiol/blood ; Female ; Fertility Preservation/*methods ; Fertilization in Vitro ; Humans ; Infertility, Female/surgery ; Neoplasms ; Nitriles/therapeutic use ; Oocyte Retrieval/*methods ; Ovulation Induction/*methods ; Retrospective Studies ; Triazoles/therapeutic use

The purpose of this study was to investigate the influence of blood coagulation reagents stored for different time on test results of the specimens prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (Fib). A total of 21 patient plasma specimens was taken and measured for homeostasis by Sysmex CA7000 automated blood coagulation analyzer and supporting reagent. The PT, APTT, TT and Fib of specimens were measured with the reagents stored in Sysmex CA7000 for different time. The differences of PT, APTT, TT and Fib were analyzed between values measured of the reagents stored for 0 hour and different time (TS:12, 24, 36,48, 60, 72 h; DA:24, 48, 72, 96, 120 h; TT:2, 4, 6, 8, 10, 12 h; TR:4, 8, 12, 16, 20, 24 h; OVB:1, 2, 3, 4, 5 ,6 h), respectively. The results showed that when coagulation reagent TS were stored for more than 48 h , DA 96 h, TT 10 h, TR 16 h and OVB 4 h, the values of PT, APTT, TT and Fib of samples were statistically different from the values measured with fresh coagulation reagent (P < 0.01), respectively. Compared 0 h with TS stored for 48-72, DA 96-120, TT 10-12, TR 16-24 and OVB 4-6 h, the percentage difference of PT, APTT, TT and Fib is in -2.6% ∼ 10.8%, -3.44% ∼ 4.8%, -3.9% ∼ 5.52%, -10.8% ∼ 3.3% and -17.2% ∼ 0.5%, the PT and Fib changes were more significant. Accordingly, the result of PT, APTT and TT had a uptrend as the reagent stored in Sysmex CA7000 analyzer for a long time, while Fib downtrend. It is concluded that the reagents showed be timely replaced when the plasma coagulation test is performed so as to obtain accurate results of examination.
Blood Coagulation ; Blood Coagulation Tests ; Blood Preservation ; methods ; Fibrinogen ; Hemostasis ; Humans ; Indicators and Reagents

OBJECTIVE: To investigate whether granulocyte-colony stimulating factor (G-CSF) can decrease the extent of ovarian follicle loss caused by cisplatin treatment. METHODS: Twenty-one adult female Sprague-Dawley rats were used. Fourteen rats were administered 2 mg/kg/day cisplatin by intraperitoneal injection twice per week for five weeks (total of 20 mg/kg). Half of the rats (n=7) were treated with 1 mL/kg/day physiological saline, and the other half (n=7) were treated with 100 microg/kg/day G-CSF. The remaining rats (n=7, control group) received no therapy. The animals were then euthanized, and both ovaries were obtained from all animals, fixed in 10% formalin, and stored at 4degrees C for paraffin sectioning. Blood samples were collected by cardiac puncture and stored at -30degrees C for hormone assays. RESULTS: All follicle counts (primordial, primary, secondary, and tertiary) and serum anti-Mullerian hormone levels were significantly increased in the cisplatin+G-CSF group compared to the cisplatin+physiological saline group. CONCLUSION: G-CSF was beneficial in decreasing the severity of follicle loss in an experimental rat model of cisplatin chemotherapy.
Animals ; Anti-Mullerian Hormone/blood ; Antineoplastic Agents/*toxicity ; Biological Markers/blood ; Cisplatin/*toxicity ; Disease Models, Animal ; Drug Evaluation, Preclinical/methods ; Female ; Fertility Preservation/methods ; Granulocyte Colony-Stimulating Factor/*therapeutic use ; Ovarian Follicle/drug effects/pathology ; Primary Ovarian Insufficiency/blood/chemically induced/pathology/*prevention & control ; Rats, Sprague-Dawley

OBJECTIVETo investigate the influence of serum storage on the laboratory results of serum T-PSA, F-PSA and FPSA%.

METHODSUsing automated chemiluminescence, we detected and compared the values of serum T-PSA, F-PSA and F-PSA% in the serum stored in different conditions.

RESULTSWhen the serum was stored at 4 degrees C or at the room temperature (22 - 26 degrees C), FPSA was unstable as compared with T-PSA. Compared with the initial value, after 4 hours at the room temperature, F-PSA was decreased to (0.392 +/- 0.246) microg/L (P < 0.01), while T-PSA and F-PSA% to (1.522 +/- 1.085) microg/L and (25.03 +/- 5.94)%, respectively, with no significant difference; after 8 hours at the room temperature, T-PSA and F-PSA were reduced to (1.513 +/- 1.083) and (0.389 +/- 0.247) microg/L (P < 0.05 and P < 0.01). At 4 degrees C, T-PSA, F-PSA and F-PSA% were decreased to (9.418 +/- 7.965) microg/L, (2.168 +/- 1.558) micro/L and (26.6 +/- 6.63)%, respectively, after 2 days (P < 0.05), and to (9.203 +/- 7.736) microg/L, (2.047 +/- 1.478) microg/L and (25.64 +/- 6.56)% after 1 week (P < 0.01). At -40 degrees C, T-PSA, F-PSA and F-PSA% were (4.532 +/- 4.393) microg/L, (1.178 +/- 1.034) microg/L and (24.45 +/- 8.81)% after 4 weeks. When the serum was stored at -40 degrees C and after 3 freeze-thaws, F-PSA and T-PSA were (5.982 +/- 5.314) and (1.341 +/- 1.029) microg/L, respectively, with no significant difference from the initial values.

CONCLUSIONDifferent conditions of serum storage have different influences on the laboratory results of serum TPSA, F-PSA and F-PSA%, more on F-PSA than on T-PSA, while F-PSA% is relatively stable. At -40 degrees C, T-PSA and F-PSA may remain stable for a month at least. Repeated freeze-thaws of the serum do not affect the laboratory results of F-PSA and T-PSA.

Autoanalysis ; Blood Preservation ; methods ; Humans ; Male ; Prostate-Specific Antigen ; blood ; Serum ; Temperature

This study was purposed to explore the influence of S-nitrosoglutathione (GSNO) on membrane glycoprotein of frozen platelet. The levels of membrane glycoprotein on fresh liquid platelets, frozen platelets and frozen platelets with GSNO were measured by flow cytometry. The results showed that the GSNO obviously decreased platelet aggregation, the PAC-1 change in the three groups was not significant. The changes of CD42b and CD62P in fresh liquid platelet group, frozen platelet group and frozen platelets with GSNO were significant different. The change of membrane glycoprotein in above-mentioned three group was not significant. It is concluded that the GSNO inhibits platelet aggregation, maintains the function of platelets and may be used as a cryoprotectant. When frozen platelets were added with GSNO, the molecular rearrangement, structure change and other mechanism may occur in platelets.
Blood Platelets ; drug effects ; Blood Preservation ; methods ; Freezing ; Humans ; P-Selectin ; metabolism ; Platelet Activation ; drug effects ; Platelet Glycoprotein GPIb-IX Complex ; metabolism ; Platelet Membrane Glycoproteins ; metabolism ; S-Nitrosoglutathione ; pharmacology

This study was purposed to evaluate the effect of different lyophilizing protectants including human albumin, glucan, polyvinyl pyrrolidone and glycerine on lyophilized trehalose-loading red blood cells (RBC), then to screen the optimal lyophilizing protectant. The RBC were incubated in 800 mmol/L concentration of trehalose solution at 37°C for 7 hours, and washed 3 times with PBS solution to obtain the trehalose-loading RBC. The trehalose-loading RBC in control group were directly lyophilized without lyophilizing protectants, the trehalose-loading RBC in the experimental group were mixed with Lyophilizing protectants. The samples of 2 groups were kept at room temperature for 30 minutes, pre-frozen at -80°C for 24 hours, then lyophilized in freeze-dryer for 24 hours. Finally the samples were quickly rehydrated by 6% HES at 37°C. The recovery rate and hemolysis rate of hemoglobin were detected by using cyanohemoglobin detection kit. The water content of unhydrated samples were detected at the same time. The results showed that when the moisture content of sample was 3% - 5%, the recovery rate of hemoglobin in control group was 33.57 ± 2.89%, and that in experimental group was 51.15 ± 1.98%, there was statistically significant difference between the control and experimental group (P < 0.05). When the different concentration of dextran solution was chosen as protectants, the recovery rate of hemoglobin of lyophilized RBC was obviously lower. The higher concentration of dextran, the better the recovery rate. The recovery rate of hemoglobin was 22.15 ± 4.12% when the concentration of dextran was 36%, there were statistically significant difference between the two groups (P < 0.05). When the different concentration of polyvinyl pyrrolidone (PVP) solutions was chosen as protectants, especially the concentration below 40%, the recovery rate of hemoglobin of lyophilized RBC was significantly belower than the control group, there was statistically significant difference between the two groups (P < 0.05). When 10% glycerol was used as protectants, the recovery rate of hemoglobin was 3.93 ± 1.80%. There was also statistically significant difference between the two groups (P < 0.05). It is concluded that human serum albumin shows an important protective effect on the lyophilization of the trehalose-loading red blood cells. The dextran and PVP at the concentration lower than 40% can decrease the protective effect of trehalose in cells. Glycerol can not be chosen as protectant for lyophilized trehalose-loading red blood cells.
Blood Preservation ; methods ; Cryoprotective Agents ; pharmacology ; Erythrocytes ; drug effects ; Freeze Drying ; methods ; Humans ; Trehalose ; pharmacology

The right choice of frozen protective agents and additives is an important factor to ensure the quality of frozen platelets. The immediate hemostatic function of frozen platelet in vivo is superior to liquid-stored platelets. In order to ensure the quality of frozen platelets better, it is important to understand the role of dimethylsulfoxide (DMSO) in the preservation of frozen platelets and its mechanism, and to understand the mechanism of DMSO enhancing the hemostatic function of frozen platelets and the effects of different factors on the frozen platelets. In this review, the long-term preservation of frozen platelets and its quality standards, the mechanism of DMSO effect on the molecular changes and inhibition of frozen platelets, different factors influencing preservation freezing platelets and the test of preservation effects, the application of frozen platelets to the military operation and disaster relief, the canine frozen platelet studies and so on are summarized.
Animals ; Blood Platelets ; Blood Preservation ; methods ; Cryopreservation ; Cryoprotective Agents ; Dimethyl Sulfoxide ; Dogs ; Humans

This study was purposed to evaluate the effect of trehalose-loading on physiological and biochemistry properties of red blood cell (RBC) membrane. The samples were divided into the control group (RBC without trehalose loading) and the test group (RBC with trehalose loading). Osmotic fragility reaction was used to determine the osmotic fragility change of loaded RBC membrane in NaCl solution of different osmotic concentration. Flow cytometry and deformeter were used to assay the integrality and deformability of the RBC, respectively. The results showed that the NaCl solution osmotic concentrations were 160 mOsm and 121.4 mOsm, respectively when the haemolysis rate was 50% of the control group and the test group. Flow cytometry data demonstrated that incubation of RBC in a hypertonic trehalose solution resulted in a fraction of cells with different complexity that attached to little Annexin V-FITC, and that it could be removed by washing and resuspending the RBC in an iso-osmotic (300 mOsm PBS) medium. The deformability of the loaded RBC descend, the statistical difference was significant between control and test groups (P < 0.01). It is concluded that the membrane physiological and biochemistry stability and membrane integrality of RBC in a hyper osmotic pressure can be retained after trehalose loading.
Blood Preservation ; methods ; Cryopreservation ; methods ; Erythrocyte Membrane ; drug effects ; Erythrocytes ; drug effects ; Humans ; Osmotic Fragility ; drug effects ; Trehalose ; pharmacology