Recommendations For Intraoperative Blood Cell Salvage In Obstetrics

AUTOLOGOUS TRANSFUSION

The filtered blood is washed and resuspended in saline for transfusion. It may be re-transfused either during or after the operation. The aspirate may include amniotic fluid and blood cells from the fetus. A leukocyte depletion filter is nearly always used in this process to reduce the amount of amniotic fluid contaminants in transfused blood to levels approaching those found in maternal blood. Indications Blood replacement may be required in obstetric practice during cesarean section, or after vaginal delivery in patients with conditions such as placenta previa or placenta accreta. This procedure may reduce the incidence of transfusion reactions and transfusion-related infection, compared with allogenic transfusion, and may also be useful when there are difficulties with cross-matching. Intraoperative blood cell salvage is commonly used in cardiac, orthopaedic and vascular surgery. Safety In the blood cell salvage arm of a comparative study of 68 women who had a cesarean section, there were no reported complications from re-infusing salvaged blood. Unused salvaged blood from 15 women was analysed and found to contain foetal haemoglobin at a concentration of 1.8–2.0% in 20% of cases. Studies report negligible complications by using salvaged blood treated with a leukocyte depletion filter. Although there is evidence of the safety of cell salvage and autotransfusion without anticoagulation, anticoagulants are still utilized. As such, certain conditions should be fulfilled to achieve safety in the procedure of cell salvage and autotransfusion. Overall, it is noted that intraoperative blood salvage is a simple, effective and safe method of blood replacement. Its use should be of primary consideration in the management of ruptured ectopic pregnancy. Sources Patterson JA1, Roberts CL, Bowen JR, Irving DO, Isbister JP, Morris JM, Ford JB (2014). Blood transfusion during pregnancy, birth, and the postnatal period Obstet Gynecol. 2014 Jan;123(1):126-33 National Institute for Health and Clinical Excellence. Intraoperative blood cell salvage in obstetrics: NICE interventional procedure guidance 144. 2005

The autologous blood transfusion, particularly intraoperative cell salvage, is important in the management of the acute ruptured ectopic pregnancy. These NICE guidelines highlight the recommendations for use of intraoperative blood cell salvage. Intraoperative cell salvage is a strategy to decrease the need for allogeneic blood transfusion. With advances in cell salvage technology, the risks of cell salvage in the obstetric population parallel those in the general population. Levels of foetal squamous cells in salvaged blood are comparable to those in maternal venous blood at the time of placental separation. No definite cases of amniotic fluid embolism have been reported and appear unlikely with modern equipment. Intraoperative blood cell salvage Intraoperative blood cell salvage is an efficacious technique for blood replacement and its use is well established in other areas of medicine, but there are theoretical safety concerns when it is used in obstetric practice. Cell salvage is cost-effective in patients with predictably high rates of transfusion, such as parturients with abnormal placentation. Recommendations Procedure Intraoperative blood cell salvage is the process whereby blood shed during the surgery is collected, filtered and washed to produce autologous red blood cells for transfusion to the patient. During cesarean section, the blood lost during the operation is aspirated from the surgical field using a catheter. The blood is then suctioned into a reservoir in which a filter removes gross debris.