Acute Kidney Injury Secondary to Cell Saver in Posterior Spinal Fusion

Abstract

Background: Autologous blood transfusion, commonly referred to as cell saver, is frequently used in spinal fusion to salvage red blood cells because of the risk of significant intraoperative blood loss. This case report describes a case of acute kidney injury (AKI) secondary to cell saver use. Our objective is to increase the knowledge about the process of red blood cell salvage and this exceedingly rare complication.

Methods: Chart and renal biopsy results for a single case were reviewed and reported in this retrospective study.

Results: A healthy 18-year-old male patient underwent posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis with utilization of intraoperative autologous blood transfusion. The patient subsequently developed hematuria and AKI with a peak creatinine of 13.9 mg/dL. An extensive clinical workup, including autoimmune serology, excluded any identifying causes. A renal biopsy showed pigment-induced acute tubular necrosis.

Conclusions: This case, to our knowledge, is the first and only case report of AKI secondary to cell saver demonstrated by renal biopsy. The literature has shown both the benefit of cell saver by decreasing the need for allogeneic transfusion and the risk of transient hematuria. However, this case demonstrates the importance of monitoring patients for potential complications.

Keywords: Acute Kidney Injury; Adolescent Idiopathic Scoliosis; Autologous Blood Transfusion; Cell Saver; Level IV; Pigment-Induced Acute Tubular Necrosis.