The introduction of intra-operative cell salvage in obstetric clinical practice: a review of the available evidence

• Published in: European journal of obstetrics & gynecology and reproductive biology 2011-11, Vol.159 (1), p.19-25
• Main Authors: Liumbruno, Giancarlo Maria, Meschini, Antonella, Liumbruno, Chiara, Rafanelli, Daniela
• Format: Article
• Language: English
• Subjects: Autologous blood; Biological and medical sciences; Blood Safety; Blood transfusion; Blood Transfusion, Autologous - adverse effects; Contraindications; Delivery. Postpartum. Lactation; Efficacy; Embolism, Amniotic Fluid - prevention & control; Evidence-Based Medicine; Female; Filtration; Gynecology. Andrology. Obstetrics; Humans; Intra-operative cell salvage; Leukocyte Reduction Procedures; Medical sciences; Obstetric Labor Complications - therapy; Obstetric Surgical Procedures - adverse effects; Obstetrics; Obstetrics and Gynecology; Operative Blood Salvage - adverse effects; Operative Blood Salvage - methods; Pregnancy; Safety
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2011.06.011

Abstract Intra-operative blood salvage is common practice in many surgical specialties but its safety is questioned with concerns about the risks of contamination of recovered blood with amniotic fluid and of maternal–foetal alloimmunization. However, the role of cell salvage as a blood-saving measure in this clinical setting is progressively acquiring relevance thanks to the growing body of evidence regarding its quality and safety. Modern cell savers remove most particulate contaminants and leukodepletion filtering of salvaged blood prior to transfusion adds further safety to this technique. Amniotic fluid embolism is no longer regarded as an embolic disease and the contamination of the salvaged blood by foetal Rh-mismatched red blood cells can be dealt with using anti-D immunoglobulin; ABO incompatibility tends to be a minor problem since ABO antigens are not fully developed at birth. Maternal alloimmunization can be caused also by other foetal red cell antigens, but it should also be noted that the risk of alloimmunization of the mother from allogeneic transfusion may be even greater. Therefore the use of cell savers in obstetric clinical practice should be considered in patients at high risk for haemorrhage or in cases where allogeneic blood transfusion is difficult or impossible.