Cell Salvage
Cell salvage involves:
- Collecting blood from the surgical field
Low-pressure to avoid haemolysis. Citrate is added immediately to prevent coagulation.- Continuous
- Intermittent
- Washing and filtering blood
Removal of contaminants. - Separation
Centrifuge of red cells. - Reinfusion
Salvaged, citrated blood is collected in a bag, stored at room temperatures, and must be reinfused within 4 hours.
Indications
Relative indications:
- Significant blood loss
- Cardiac surgery
- Vascular surgery
- Rare blood groups/auto-antibodies
- Religious groups with objections to transfusion
May not be acceptable to all. - Reduced blood bank access
Advantages
- Reduces transfusion by up to 40%
- Cost
- Transfusion reactions
- Higher 2,3-DPG than allogenic blood
Disadvantages
- Cost
- Initial cost is expensive, value will depend on use frequency
- Haemolysis
- Absence of coagulation factors
May lead to dilutional coagulopathy. - Embolism
- Air
- Fat
- Microaggregates
- Salvaged blood syndrome
- Citrate load
Calcium required to reverse. - TACO
- Hypotension
Due to bradykinin from leukodepletion filters.
Special Circumstances
Controversy remains around:
- Malignancy
Concern about reinfusion of tumour cells, but no evidence of this. - Contamination
Potential for bacteraemia if salvage from contaminated site; use is not recommended. - Obstetrics
Risk of:- AFE
No evidence, but double suction used with the non-amniotic suction used to remove amnion. - Rhesus sensitisation
From foetal blood; mitigate with giving mother anti-D.
- AFE