Use of the Hemosep® ultrafiltration system in a patient admitted to NUH City Hospital with 7.4cm ascending aortic aneurysm, 4.7cm aortic root and aortic valve regurgitation. Spiritual beliefs prohibited transfusion of any donated blood products or reinfusion of autologous blood that left the body. Patient preoperative haemoglobin was 157g/L, but platelets were 152 g/L.

Intra Operative Cell Salvage (IOCS) was attached in a continuous loop to the patient but not used to process blood during the procedure. IOCS acted as a continuous loop to which another blood conservation technique could be implemented. Although IOCS provides an excellent method of preserving Red Blood Cells (RBCs) it does not preserve platelets. The use of the Hemosep® (Advancis Medical) ultrafiltration device was favoured as patient preoperative platelet levels were low. In addition to RBCs preservation, this system also retains white blood cells and platelets that would otherwise be lost following IOCS. Following central cannulation the patient underwent 274 minutes of cardiopulmonary bypass (CPB) at a temperature of 32℃. Cross-clamp (XC) time was 237 minutes and myocardial protection was achieved using intermittent antegrade and retrograde blood cardioplegia.

Blood was collected and processed from a central cell saver reservoir, and diverted to the Hemosep® ultrafiltration device. 9 bags were used, with the majority used after the case to concentrate the residual pump volume. After processing, patient Hb was 141g/L and platelets were 130g/L, rising to 189g/L seven days after surgery.

This case demonstrated the ability of the team to adapt their practice to provide a safe outcome whilst accommodating the patients’ beliefs. The Hemosep® system is a safe device for use in non-transfusion surgery and can enhance mean platelet count post-surgery compared to conventional cell salvage therapy alone.  The patient made a full recovery and was discharged without any complications.