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.
Abbreviations:
ACD (acid–citrate–dextrose), AF (amniotic fluid), AFE (amniotic fluid embolism), AFP (α-fetoprotein), CS (caesarean section), DIC (disseminated intravascular coagulation), ICS (intra-operative cell salvage), Ig (immunoglobulin), LDF (leukodepletion filter), PPH (post-partum haemorrhage), RBC (red blood cell), SB (salvaged blood), SC (squamous cell), SHOT (Serious Hazards of Transfusion), TF (tissue factor)Keywords
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References
- Challenges of major obstetric haemorrhage.Best Pract Res Clin Obstet Gynaecol. 2010; 24: 353-365
- Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group.BMC Pregnancy Childbirth. 2009; 9: 55
- Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA, and the World Bank.WHO, Geneva, Switzerland2007 ([last accessed: 02/01/2011]. Available from:)
- Attending to 136 million births, every year.in: WHO The world health report 2005: make every mother and child count. WHO, Geneva, Switzerland2005 (p. 62 [last accessed: 02/01/2011]. Available from:)
- Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.BJOG. 2011; 118: 1-203
- Quantifying severe maternal morbidity: a Scottish population study.BJOG. 2004; 111: 481-484
- Maternal mortality: who, when, and why.Lancet. 2006; 368: 1189-1200
- Incidence of severe pre-eclampsia, postpartum haemorrhage and sepsis as a surrogate marker for severe maternal morbidity in a European population-based study: the MOMS-B survey.BJOG. 2005; 112: 89-96
- Erythrocyte salvage during cesarean section.Anesthesiology. 2000; 92: 1519-1522
- Dutch orthopedic blood management surveys 2002 and 2007: an increasing use of blood-saving measures.Arch Orthop Trauma Surg. 2010; 130: 55-59
- Cell salvage in obstetrics.Int J Obstet Anesth. 2008; 17: 37-45
- Intraoperative cell salvage in obstetrics.Clin Risk. 2008; 14: 14-17
- Red blood cell recovery and reinfusion.Anesthesiol Clin N Am. 2005; 23: 283-294
- Intraoperative blood management.in: Waters J.H. Perioperative blood management. A physician's handbook. 1st ed. AABB, Bethesda, Maryland2006 (p. 45–76)
- Perioperative blood conservation.Eur J Anaesthesiol. 2009; 26: 722-729
- Yield of HCV and HIV-1 NAT after screening of 3.6 million blood donations in central Europe.Transfusion. 2002; 42: 862-868
- Taylor C. The 2009 Annual SHOT Report (2010). SHOT, Manchester, UK2010 ([last accessed: 02/01/2011]. Available from:)
- Cell salvage in the Jehovah's Witness.Anesth Analg. 2000; 90: 229-230
- Intraoperative cell salvage: a fresh look at the indications and contraindications.Blood Transfus. 2011; 9: 139-147
- The future of blood management.Clin Lab Med. 2010; 30: 453-465
- Cost-effectiveness of cell salvage and alternative methods of minimizing perioperative allogeneic blood transfusion: a systematic review and economic model.Health Technol Assess. 2006; 10: 1-210
- Economic analysis of an intraoperative cell salvage service.Anesth Analg. 2004; 98: 201-205
- A prospective study investigating the cost effectiveness of intraoperative blood salvage during liver transplantation.Transplantation. 2006; 81: 536-540
- An economic analysis of costs associated with development of a cell salvage program.Anesth Analg. 2007; 104: 869-875
- Cost effectiveness of using a cell saver in a large obstetric unit.Int J Obstet Anesth. 2007; 16: S5
- ACOG committee opinion. Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists.Int J Gynaecol Obstet. 2002; 77: 77-78
- ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician–Gynecologists. Number 76, October 2006: postpartum hemorrhage.Obstet Gynecol. 2006; 108: 1039-1047
- Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.Anesthesiology. 2007; 106: 843-863
- Recommendations for the transfusion management of patients in the peri-operative period. II. The intra-operative period.Blood Transfus. 2011; 9: 189-217
- Haemorrhage.in: Lewis G. Why mothers die 2000–2002. The sixth report of the confidential enquiries into maternal deaths in the United Kingdom. RCOG Press, London, UK2004 (p. 91–92 [last accessed: 02/01/2011]. Available from:)
- Intraoperative blood cell salvage in obstetrics. Interventional procedure guidance 144.National Institute for Health and Clinical Excellence, London, UK2005 ([last accessed: 02/01/2011]. Available from:)
- Obstetric Anaesthetists’ Association.OAA/AAGBI guidelines for obstetric anaesthetic services. Revised edition 2005.The Association of Anaesthetists of Great Britain and Ireland, London, UK2005 (p. 25 [last accessed: 02/01/2011]. Available from:)
- Blood transfusion and the anaesthetist. Intra-operative cell salvage.The Association of Anaesthetists of Great Britain and Ireland, London, UK2009 (p. 11 [last accessed: 02/01/2011]. Available from:)
- Indications and contraindications.in: UK Cell Salvage Action Group Intraoperative cell salvage: education workbook. UK Cell Salvage Action Group, UK2008 (p. 50–52 [last accessed: 02/01/2011]. Available from:)
- Massive obstetric haemorrhage.Curr Anaesth Clin Care. 2005; 16: 181-188
- Identifying women most likely to benefit from prevention strategies for postpartum hemorrhage.J Perinatol. 2009; 29: 422-427
- Care in normal birth: a practical guide.WHO, Geneva, Switzerland1996 (p. 31 [last accessed: 02/01/2011]. Available from:)
- A simplified device for intraoperative autotransfusion.Obstet Gynecol. 1988; 72: 947-950
- The management of placenta percreta: conservative and operative strategies.Am J Obstet Gynecol. 1996; 175: 1632-1638
- Optimal management strategies for placenta accreta.BJOG. 2009; 116: 648-654
- A pregnant woman with irregular erythrocyte antibodies for whom no compatible packed red blood cells were available.Ned Tijdschr Geneeskd. 2005; 149: 2633-2636
- Acute normovolemic hemodilution, intraoperative cell salvage and PulseCO hemodynamic monitoring in a Jehovah's Witness with placenta percreta.Int J Obstet Anesth. 2008; 17: 159-163
- Application of cell-salvage during cesarean section.Anesthesiology. 1999; 90: 619-621
- The safety of intraoperative autologous blood collection and autotransfusion during cesarean section.Am J Obstet Gynecol. 1998; 179: 715-720
- Intraoperative autotransfusion. Experience in 725 consecutive cases.Ann Surg. 1983; 197: 536-541
- Autotransfusion during cesarean section.Am J Obstet Gynecol. 1990; 162: 295
- Safety and effectiveness of intracesarean blood salvage.Transfusion. 1993; 33: 181
- Is the “salvaged-cell syndrome” myth or reality?.Am J Surg. 1996; 172: 172-174
- Autologous blood transfusion.Br J Anaesth. 1998; 80: 563
- Blood salvage during caesarean section.Br J Anaesth. 1998; 80: 195-198
- Cell salvage: how safe in obstetrics?.Int J Obstet Anesth. 2000; 9: 143
- Clinical experience with cell salvage in obstetrics: 4 cases from one UK centre.Int J Obstet Anesth. 2002; 11: 128-134
- Intraoperative blood salvage during cesarean delivery in a patient with beta thalassemia intermedia.Anesth Analg. 2003; 97: 1808-1809
- Antenatal erythropoietin and intra-operative cell salvage in a Jehovah's Witness with placenta praevia.BJOG. 2003; 110: 524-526
- En caul delivery of the fetus to facilitate cell salvage.Aust N Z J Obstet Gynaecol. 2004; 44: 585
- Survey of cell-salvage use in obstetrics in the UK.Int J Obstet Anesth. 2007; 16: S30
- The use of cell salvage during obstetric procedures: an audit of Scotland's maternity units.Scott Med J. 2008; 53: 24-27
- Case of caesarean section using Cell Savers5+ in a patient with the placenta accreta associated with massive hemorrhage.Masui. 2009; 58: 499-502
- Use of cell salvage in patients with sickle cell trait.Int J Obstet Anesth. 2009; 18: 90-91
- Introduction of cell salvage to a large obstetric unit: the first six months.Int J Obstet Anesth. 2009; 18: 111-117
- Audit of cell salvage use in obstetric patients: adding experience.Int J Obstet Anesth. 2010; 19: 238-239
- The development and implementation of an obstetric cell salvage service.Anaesth Intensive Care. 2010; 38: 492-499
- Acute hypotension associated with leucocyte depletion filters during cell salvaged blood transfusion.Anaesthesia. 2010; 65: 742-744
- Severe hypotension related to cell salvaged blood transfusion in obstetrics.Anaesthesia. 2010; 65: 745-748
- Cell saver use in obstetrics.J Obstet Gynaecol. 2010; 30: 826-828
- Cell salvage-induced hypotension and London buses.Anaesthesia. 2010; 65: 659-663
- Synchronous autotransfusion during cesarean hysterectomy.Am J Obstet Gynecol. 2010; 202: e15-e16
- Cell salvage at caesarean section: the need for an evidence-based approach.BJOG. 2009; 116: 743-747
- Cell salvage at caesarean section: the need for an evidence-based approach.BJOG. 2010; 117: 122-123
- An analysis of transfusion practice and the role of intraoperative red blood cell salvage during cesarean delivery.Anesth Analg. 2007; 104: 666-672
- Pro/con debate: is cell salvage a safe technique for the obstetric patient?.SOAP Newsletter. 2005; (Fall:): 7-9
- Amniotic fluid embolism.Clin Obstet Gynecol. 2010; 53: 322-328
- Amniotic fluid removal during cell salvage in the cesarean section patient.Anesthesiology. 2000; 92: 1531-1536
- Squamous and trophoblastic cells in the maternal pulmonary circulation identified by invasive hemodynamic monitoring during the peripartum period.Am J Obstet Gynecol. 1986; 155: 999-1001
- Amniotic fluid embolism.Anesth Analg. 2009; 108: 1599-1602
- Amniotic fluid embolism: an evidence-based review.Am J Obstet Gynecol. 2009; 201: 445.e1-445.e13
- UK Obstetric Surveillance System. Incidence and risk factors for amniotic-fluid embolism.Obstet Gynecol. 2010; 115: 910-917
- Amniotic fluid embolism – an update.Anaesthesia. 2011; 66: 3-6
- Amniotic fluid embolism: decreased mortality in a population-based study.Obstet Gynecol. 1999; 93: 973-977
- Rheologic and cytologic study of autologous blood collected with Cell Saver 4 during cesarean.Rev Fr Transfus Hemobiol. 1989; 32: 179-191
- Clearance of fetal products and subsequent immunoreactivity of blood salvaged at cesarean delivery.Obstet Gynecol. 1999; 93: 968-972
- An in vitro assessment of amniotic fluid removal from human blood through cell saver processing.Anesthesiology. 1991; 75: A830
- Evaluation of the blood quality collected by cell-saver during cesarean section.Ann Fr Anesth Reanim. 1996; 15: 1162-1167
- The ability of the Haemonetics 4 Cell Saver System to remove tissue factor from blood contaminated with amniotic fluid.Anesth Analg. 1997; 85: 831-833
- Cell salvage in obstetrics: an evaluation of the ability of cell salvage combined with leucocyte depletion filtration to remove amniotic fluid from operative blood loss at caesarean section.Int J Obstet Anesth. 1999; 8: 79-84
- Contamination of salvaged maternal blood by amniotic fluid and fetal red cells during elective Caesarean section.Br J Anaesth. 2008; 101: 225-229
- Amniotic fluid contains tissue factor, a potent initiator of coagulation.Am J Obstet Gynecol. 1991; 165: 1335-1341
- Guidelines for the use of prophylactic anti-D immunoglobulin.British Society for Haematology, London, UK2006 ([last accessed: 02/01/2011]. Available from:)
- Working party of the British Committee for Standards in Haematology, Transfusion Taskforce. Guidelines for the estimation of fetomaternal haemorrhage.British Society for Haematology, London, UK2009 ([last accessed: 02/01/2011]. Available from:)
- Prenatal and childhood transfusions.in: Murphy M. Pamphilon D. Practical transfusion medicine. 2nd ed. Blackwell Publishing, Oxford, UK2005: 97-118
- Leucocyte depletion filter and a second suction circuit during intra-operative cell salvage in obstetrics.Anaesthesia. 2010; 65: 207-208
Article info
Publication history
Published online: June 27, 2011
Accepted:
June 9,
2011
Received in revised form:
May 13,
2011
Received:
March 2,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
