Observation on the Efficacy of Autologous Blood Transfusion Combined with Controlled Hypotension in Patients with Spinal Internal Fixation during the Outbreak of New Coronavirus Pneumonia in Western Guangxi (in Guixi)

Objective: To explore the therapeutic effect of autologous blood reinfusion combined with controlled hypotension in surgical spinal fixation during the outbreak of COVID-19. Methods: 30 patients with spinal internal fixation autologous blood transfusion combined with controlled hypotension were selected as the subjects during the epidemic period from December 2019 to June 2020 in our hospital and during the operation, on the basis of routine blood pressure reduction, the American Haemonetice Corporation autologous blood continuous reinfusion system was used to infuse the blood recovered during the operation to the patient through filtration and other procedures. Results: 30 patients had no complications such as fever and hemolysis; And after the operation, the tube was dialed according to the drainage volume, the cervical thoracic and lumbar brace was customized, and the patient walked on the ground for one week; After no abnormalities, the patient was discharged. Intraoperative comparison of white blood cells (WBC), red blood cells (RBC), time (PT) of patients with autologous blood before and after transfusion showed statistically significant differences before and after surgery (P < 0.001). Con-clusion: During the new coronavirus pneumonia epidemic, the internal fixation of spinal surgery used a recovery machine to collect intraoperative blood for reinfusion. Intraoperative antihypertensive drugs were used to control blood pressure within a certain safe range. The postoperative clinical observation effect was significant and safe; especially at present the clinical significance during the epidemic was significant.


Introduction
With the development of society and the advancement of science and technology, the incidence of trauma continues to rise, and high-energy trauma is becoming more common. From 2004 to 2015, accidents on highways and buildings in China involved more than 200,000 casualties, with a total fatality rate of 33.87%.
Beginning in the 1970s, the construction of trauma centers in developed countries has replaced the three-peak model by the single-peak model [1]. According to the fifth general survey of health services in China, about 700,000 people die from trauma every year, ranking the fifth of the total cause of death [2]. Trauma will cause great pain and casualties in a very short period of time, and the losses caused by subsequent injuries and disabilities are more serious. The annual medical expenses caused by trauma in China are as high as 65 billion yuan [2] [3]. In my country, according to statistics, the amount of clinical blood used is increasing at a rate of 10% per year. The blood supply is in short supply. Patients undergoing surgery must donate blood through mutual assistance before surgery.
In addition, some relatives of patients cannot donate blood due to blood diseases; especially patients undergoing emergency surgery during the COVID-19 epidemic have seriously affected the lives and treatment capabilities of patients [4]. How to safely and effectively manage blood for these special groups of people during orthopedic surgery during the epidemic is worth pondering. Wu Wei et al. [5] reached an expert consensus on the standardized procedures for orthopedic diagnosis and treatment during the new coronavirus pneumonia epidemic. Zhang Yaoshen, Lv Hongzhi, Wang Xiuli et al. [ to the treatment of the lives of the wounded. In recent years, blood management is an emerging discipline and a new research focus. Intraoperative and postoperative autologous blood transfusion is more widely used clinically, especially during the epidemic period, and many advantages are more prominent. In 2017, our hospital introduced the American autologous blood reinfusion system. Our department began to apply the American Haemonetice Corporation autologous blood reinfusion system to autologous blood reinfusion for patients with spinal surgery. Good results have been achieved without adverse reactions. Autologous blood transfusion is safe and effective during the outbreak of new coronavirus pneumonia.

General Information
This group selected 30 patients with spinal internal fixation who were hospitalized for surgery from December 2019 to June 2020 during the epidemic. Requirements for selected patients: A. The operation is more difficult, the operation time is estimated to be long, and there is a lot of blood during the operation; B.
Those who have a history of severe blood transfusion reactions; C. Previous blood matching difficulties or rare blood types; D. Strengthen epidemiological screening of inpatients; E. All patients and their companions will be tested for new coronavirus nucleic acid and chest CT. Among the patients, 3 were cervical fractures, 10 were thoracolumbar fractures, 3 were multilevel cervical spinal stenosis, 11 were lumbar spinal stenosis, and 3 were lumbar unstable spondylolisthesis, see Table   1 below for details. Including 20 men and 10 women, aged 15 -70 years. The average is 51 years old. During the operation and after the operation, the Haemonetice Corporation autologous blood reinfusion system of the United States was used to return the blood recovered during the operation to the patient.

Intraoperative Autotransfusion Method
In this study, the intraoperative autologous blood reinfusion system of Haemonetice Corporation of the United States was used to connect a sterile tube before the operation, and put normal saline moistened with heparin into the blood reservoir. Use a suction device to fully absorb the blood during the operation,

The Statistical Processing
The statistical processing uses the SPSS 20.0 software to carry on the statistical analysis to the obtained data. Measurement data is expressed by (X ± s), and comparison is by t test; count data is expressed by rate (%), and comparison is by X 2 test. The difference was statistically significant with P < 0.05.

Result
Intraoperative statistical results of 30 patients: the total bleeding volume of the patients was 34,900 ml, with an average bleeding volume of (1163.33 ± 678.86) ml per case; the total recovered blood volume was 17,997 ml, accounting for 51.6% of the total bleeding volume, and the average recovery per case was  Table 2 and Table 3 below. All recovered washed red blood cells were

Discussion
Autologous Especially under the influence of the current new coronavirus epidemic, the blood source is even more tense, and the rare blood type is severely lacking, making it impossible for some rare blood type patients to perform surgery [9]. ing the operation, 13 cases were transfused with frozen plasma due to heavy bleeding, and 6 cases were transfused with allogeneic blood and frozen plasma due to excessive bleeding due to autologous blood transfusion, which could not meet the blood transfusion requirements, which greatly saved the blood source.
The blood safety is guaranteed.

Autologous Blood Transfusion Technology Has its Indications and Contraindications [10]
Indications: 1) Elective surgery with expected large intraoperative blood loss:

Complications of Autologous Blood Transfusion
1) Like conventional blood transfusion, complications such as fever, hemoglobinuria, allergic reactions, and coagulation abnormalities also occur in autologous blood transfusion; 2) Bleeding complications: the blood endogenous heparin concentration of normal people is very low, and proper heparin concentration during surgery is a prerequisite for blood recovery which too low cannot achieve the purpose of anticoagulation, and too high can easily cause spontaneous bleeding; Therefore, a proper and reasonable heparin concentration is of great significance to the success or failure of the operation. 4) Coagulation dysfunction. Chen Lingkun, Wang Weiming et al. [13] [14] study that patients with massive bleeding (more than 3000 ml) lose too much platelets and coagulation factors in the blood, so long as the coagulation factors in the body maintain part of the coagulation function. Therefore, patients with massive bleeding need to be infused with fresh frozen plasma, which contains suspected blood factor components and can supplement the clotting factor components lost due to massive blood loss. Chen Lingkun, Wang Weiming et al. [13] [14] study that patients with massive bleeding (more than 3000 ml) lose too much platelets and coagulation factors in the blood, so long as the coagulation factors in the body maintain to be infused with fresh frozen plasma, which contains suspected blood factor components and can supplement the clotting factor components lost due to massive blood loss. Liu Lin et al. [15] studied the coagulation function of preschool children undergoing spinal orthopedic surgery who also confirmed this point. Patients with small and medium bleeding will not cause coagulation dysfunction, and generally do not need to infusion of fresh frozen plasma.  [18].

Conclusions
In this study, the comparison of white blood cell (WBC), red blood cell (RBC), red blood cell pressure (HCT), hemoglobin (HGB) and clotting time (PT) of patients before and after autologous blood transfusion showed statistically significant differences before and after operation (P < 0.001); however, platelets (PLT), activated prothrombin time (APTT) and fibrinogen (FIB) did not change significantly, and the difference was not statistically significant (P > 0.05); Although there were certain differences in the relevant blood routine indexes and coagulation function indexes before and after autotransfusion, the indexes in all cases were still within the normal acceptable range, so there was no need for related treatment.
To sum up, during the COVID-19 pandemic, due to more blood loss during spinal surgery than other surgeries, spinal internal fixation surgery used a recovery machine to collect intraoperative blood for reinfusion. During the operation, blood pressure was controlled by antihypertensive drugs to a certain degree. The effect of postoperative clinical observation was significant and safe, especially during the current epidemic period.

Limitations of the Study
This study mainly observes a limited number of cases, which has certain limitations, and the number of cases can be expanded to obtain more powerful evidence. In addition, the follow-up time of this study is relatively long, and the pa-Open Journal of Blood Diseases tient's compliance with follow-up has a certain complexity, which has a certain impact on the results.