Comparison Between Return and Wastage of Your Own Blood, Collected During Spinal Surgery, for Verification of Safety When Returning Blood

• Difference in Interleukin-6 concentration [ Time Frame: At screening and at surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-6 concentration between screening and surgery.
• Difference in Interleukin-6 concentration [ Time Frame: At screening and at 3 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-6 concentration between screening and 3 hours after surgery.
• Difference in Interleukin-6 concentration [ Time Frame: At screening and at 24 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-6 concentration between screening and 24 hours after surgery.
• Difference in Interleukin-6 concentration [ Time Frame: At screening and at 48 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-6 concentration between screening and 48 hours after surgery.
• Difference in Interleukin-6 concentration [ Time Frame: At screening and at 96 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-6 concentration between screening and 96 hours after surgery.
• Difference in Interleukin-8 concentration [ Time Frame: At screening and at surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-8 concentration between screening and surgery.
• Difference in Interleukin-8 concentration [ Time Frame: At screening and at 3 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-8 concentration between screening and 3 hours after surgery.
• Difference in Interleukin-8 concentration [ Time Frame: At screening and at 24 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-8 concentration between screening and 24 hours after surgery.
• Difference in Interleukin-8 concentration [ Time Frame: At screening and at 48 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-8 concentration between screening and 48 hours after surgery.
• Difference in Interleukin-8 concentration [ Time Frame: At screening and at 96 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-8 concentration between screening and 96 hours after surgery.
• Difference in Interleukin-10 concentration [ Time Frame: At screening and at surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-10 concentration between screening and surgery.
• Difference in Interleukin-10 concentration [ Time Frame: At screening and at 3 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-10 concentration between screening and 3 hours after surgery.
• Difference in Interleukin-10 concentration [ Time Frame: At screening and at 24 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-10 concentration between screening and 24 hours after surgery.
• Difference in Interleukin-10 concentration [ Time Frame: At screening and at 48 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-10 concentration between screening and 48 hours after surgery.
• Difference in Interleukin-10 concentration [ Time Frame: At screening and at 96 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-10 concentration between screening and 96 hours after surgery.
• Difference in Interleukin-1a concentration [ Time Frame: At screening and at surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-1a concentration between screening and surgery.
• Difference in Interleukin-1a concentration [ Time Frame: At screening and at 3 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-1a concentration between screening and 3 hours after surgery.
• Difference in Interleukin-1a concentration [ Time Frame: At screening and at 24 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-1a concentration between screening and 24 hours after surgery.
• Difference in Interleukin-1a concentration [ Time Frame: At screening and at 48 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-1a concentration between screening and 48 hours after surgery.
• Difference in Interleukin-1a concentration [ Time Frame: At screening and at 96 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interleukin-1a concentration between screening and 96 hours after surgery.
• Difference in Tumor Necrosis Factor-alpha concentration [ Time Frame: At screening and at surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Tumor Necrosis Factor-alpha concentration between screening and surgery.
• Difference in Tumor Necrosis Factor-alpha concentration [ Time Frame: At screening and at 3 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Tumor Necrosis Factor-alpha concentration between screening and 3 hours after surgery.
• Difference in Tumor Necrosis Factor-alpha concentration [ Time Frame: At screening and at 24 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Tumor Necrosis Factor-alpha concentration between screening and 24 hours after surgery.
• Difference in Tumor Necrosis Factor-alpha concentration [ Time Frame: At screening and at 48 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Tumor Necrosis Factor-alpha concentration between screening and 48 hours after surgery.
• Difference in Tumor Necrosis Factor-alpha concentration [ Time Frame: At screening and at 96 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Tumor Necrosis Factor-alpha concentration between screening and 96 hours after surgery.
• Difference in Interferon-gamma concentration [ Time Frame: At screening and at surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interferon-gamma concentration between screening and surgery.
• Difference in Interferon-gamma concentration [ Time Frame: At screening and at 3 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interferon-gamma concentration between screening and 3 hours after surgery.
• Difference in Interferon-gamma concentration [ Time Frame: At screening and at 24 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interferon-gamma concentration between screening and 24 hours after surgery.
• Difference in Interferon-gamma concentration [ Time Frame: At screening and at 48 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interferon-gamma concentration between screening and 48 hours after surgery.
• Difference in Interferon-gamma concentration [ Time Frame: At screening and at 96 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: Yes ]
  Difference in Interferon-gamma concentration between screening and 96 hours after surgery.
• Mean blood loss volume [ Time Frame: After surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: No ]
• Frequency of allogenic blood transfusion [ Time Frame: 24 hours after surgery (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: No ]
• Allogenic blood transfusion volume [ Time Frame: 24 hours after transfusion (surgery takes place 1-7 days after screening) ] [ Designated as safety issue: No ]

The study is an open, randomized, controlled, single-centre study including a total of 42 evaluable subjects scheduled for spinal surgery with an approximate expected bleeding of 800-1500 ml. The Sangvia® Blood Salvage System will be set up for all subjects to collect blood intra-operatively. When the transfusion bag is filled, i.e. when around 500 ml of blood has been collected, the subject will be randomized to either be retransfused with the blood collected (investigational group) or not (control group). The primary objective for this study is to investigate the blood quality and isolate the systemic effects in intra-operatively collected blood. The systemic p-Hb concentration has been chosen as the primary outcome variable based on previous experience and literature and is considered as the major safety concern for the study subjects.

• Experimental: Sangvia and retransfusion
  Intervention: Device: Sangvia
• No Intervention: Sangvia and no retransfusion
  Intervention: Device: Sangvia

Inclusion Criteria:

• Provision of informed consent.
• Male and female subjects aged 18 years and over subjected to spinal surgery with an approximate expected bleeding of 800-1500 ml.
• Subjects classified as ASA Physical Status Classification System class P1, P2 or P3 according to the American Society of Anaesthesiology.

Exclusion Criteria:

• Involvement in the planning and conduct of the study (applies to both Astra Tech staff or staff at the study site).
• Previous enrolment or randomisation of treatment in the present study.
• Participation in another clinical study, that may interfere with the present study.
• Severe non-compliance to protocol as judged by the investigator and/or Astra Tech.
• Haemophilia.
• Hyperkalemia (i.e. values above the normal reference values at study site).
• Symptoms of impaired renal function including creatinine clearance levels (using the Cockcroft-Gault formula) <30 ml/min.
• Malignancy in the area of the operative site.
• Current or expected use of cytotoxic drugs.
• Symptoms of systemic infection or local infection in the operation field.
• Pregnancy.
• Sickle cell anaemia and/or pre-operative Hb concentration <11 g/dl (6,8 mmol/l).
• Use of recombinant erythropoietin (EPO) or fibrin sealant.
• Use of other autologous blood transfusion than with the Sangvia® system (e.g. CellSaver and pre-donation) or other blood saving techniques (e.g. normovolemic hemodilution).
• Hypotensive anesthesia.
• Use of antithrombotic medication within 5 days of surgery (NSAID, Clopidogrel).