Testing of the filter function of a prototype device to eliminate fetal surrogate markers and bacterial load for autotransfusion in postpartum haemorrhage in low-resource settings

26 www.thelancet.com/lancetgh Published Online April 8, 2016 University of Illinois, Chicago, IL, USA (B Collofello BS, N Robinson MD, V Dobiesz MD, P Kutz CCP, A Koch MA, A Harrington PhD, H Esmailbeigi PhD, S Geller PhD) Correspondence to: Brandon Collofello, 1940 W Taylor M/C 584, Center for Global Health, Chicago, IL 60612, USA bcollo2@uic.edu Testing of the fi lter function of a prototype device to eliminate fetal surrogate markers and bacterial load for autotransfusion in postpartum haemorrhage in low-resource settings Brandon Collofello, Nuriya Robinson, Valerie Dobiesz, Pam Kutz, Abby Koch, Amanda Harrington, Hananeh Esmailbeigi, Stacie Geller Abstract Background Postpartum haemorrhage is a leading cause of death in low-income and middle-income countries, but it is also largely preventable. As a potential solution for restoring blood volume in women with life-threatening haemorrhage in low-resource settings, a vaginal blood collection drape with adaptations for autotransfusion has been created. In this study, we aimed to assess the fi ltration function of the autotransfusion system prototype and to determine the degree to which the fi lter removes surrogate markers for amniotic fl uid, fetal cells, and inhibin A, as well as to quantify the reduction of bacterial contaminants in postpartum blood after vaginal delivery.Background Postpartum haemorrhage is a leading cause of death in low-income and middle-income countries, but it is also largely preventable. As a potential solution for restoring blood volume in women with life-threatening haemorrhage in low-resource settings, a vaginal blood collection drape with adaptations for autotransfusion has been created. In this study, we aimed to assess the fi ltration function of the autotransfusion system prototype and to determine the degree to which the fi lter removes surrogate markers for amniotic fl uid, fetal cells, and inhibin A, as well as to quantify the reduction of bacterial contaminants in postpartum blood after vaginal delivery. Methods We collected postpartum blood from four women who had normal spontaneous vaginal delivery of a term pregnancy using an adapted obstetrical blood collection drape. Immediately after the delivery, the research drape was placed under the buttocks of the participant and postpartum blood was collected. The blood entered a sterile system and was fi ltered through a Pall LeukoGuard BC2 Cardioplegia fi lter via a negative pressure pump. We tested prefi ltration and post-fi ltration samples for the presence of fetal cells, inhibin A, and surrogate markers for amniotic fl uid contamination. Cultures of prefi ltered and post-fi ltered blood underwent qualitative analysis, to identify specifi c bacterial species present, and quantitative analysis. Findings We identifi ed Escherichia coli, Bacteroides fragilis, Klebsiella pneumoniae, Enterococcus faecalis, Corynebacterium jeikeium, Lactobacillus spp, and Staphylococcus spp in prefi ltration blood samples. In samples from three of the four participants, bacterial load decreased after fi ltration. However, complete elimination of a bacterial species did not occur in two participants’ post-fi lter cultures. Fetal cells were present in one prefi ltration sample and decreased but remained present after fi ltration. Reduction in α-fetoprotein and inhibin A varied between the four participants’ post-fi ltration samples. Interpretation The fi lter tested in the autotransfusion system prototype did not signifi cantly reduce the surrogate markers tested nor eliminate bacteria in the four samples, although selective removal of Staphylococcus spp might have occurred. The system remains a promising solution to improve health outcomes of women who give birth in low-resource settings but improved fi lter function does need to be addressed. Future studies will test a leucocyte depletion fi lter, previously shown to successfully remove bacterial contaminants, as well as alter device fl ow rates for optimum fi lter function. Funding UIC Chancellor’s Innovation Fund: Spring 2014 Proof-of-Concept Award (V Dobiesz), UIC College of Medicine Craig Fellowship (B Collofello). Copyright © Collofello et al. Open Access article distributed under the terms of CC BY. Declaration of interests We declare no competing interests.