Cell salvage as part of a blood conservation strategy in anaesthesia

Abstract

The use of intraoperative cell salvage and autologous blood transfusion has become an important method of blood conservation. The main aim of autologous transfusion is to reduce the need for allogeneic blood transfusion and its associated complications. Allogeneic blood transfusion has been associated with increased risk of tumour recurrence, postoperative infection, acute lung injury, perioperative myocardial infarction, postoperative low-output cardiac failure, and increased mortality. We have reviewed the current evidence for cell salvage in modern surgical practice and examined the controversial issues, such as the use of cell salvage in obstetrics, and in patients with malignancy, or intra-abdominal or systemic sepsis. Cell salvage has been demonstrated to be safe and effective at reducing allogeneic blood transfusion requirements in adult elective surgery, with stronger evidence in cardiac and orthopaedic surgery. Prolonged use of cell salvage with large-volume autotransfusion may be associated with dilution of clotting factors and thrombocytopenia, and regular laboratory or near-patient monitoring is required, along with appropriate blood product use. Cell salvage should be considered in all cases where significant blood loss (>1000 ml) is expected or possible, where patients refuse allogeneic blood products or they are anaemic. The use of cell salvage in combination with a leucocyte depletion filter appears to be safe in obstetrics and cases of malignancy; however, further trials are required before definitive guidance may be provided. The only absolute contraindication to the use of cell salvage and autologous blood transfusion is patient refusal.

Elevation of Neutrophil Elastase Activity in Intra-Operative Recovered Shed Blood

“…In fact, we have reported that in rabbits, EAC itself causes acute lung injuries [8]. Recently, it has been reported that recovered shed bloods after leukocyte filtering could be a safer method even for obstetric or infected patients who were prohibited to use this autologous salvaged blood [9]. In this regard, the present results may support this expansion of the indication of intra-operative recovered shed blood.…”

Heparin-induced thrombocytopenia in solid organ transplant recipients: The current scientific knowledge

“…This is why relevant side-effects of drugs, thrombocytopenia associated to the underlying disease, sepsis, disseminated intravascular coagulation, and post transfusion purpura always have to be considered in every individual case of thrombocytopenia in ICU patients [21] . However, a platelet count drop is also well known to occur after major surgery and extracorporeal circuitry such as heart-lung machine or cell saver ® autotransfusion [22] . Drug-induced immune thrombocytopenia has been reported for calcineurin inhibitors [23] , mycofenolate, and anti-thymocyte globulin (ATG) [24,25] .…”

From Bloodless Surgery to Patient Blood Management

“…41,56 -60 Notably, several studies have indicated that leukocyte depletion filters are able to substantially reduce and remove unwanted cells and particulate materials from the salvaged blood. 61,62 Overall, intraoperative cell salvage remains a safe and effective technique in reducing allogeneic transfusions and improving patient outcomes. 17,53 On the other hand, acute normovolemic hemodilution relies on removing a part of the blood volume from the circulation and replacing it with other fluids (crystalloids or colloids) before bleeding takes place.…”