Cell Salvage
Last modified: 09 July 2022, 5:05:16 PM AEST
Gems1 / 7
- key part of PBM
- most JW will accept
Indications2 / 7
- significant blood loss
- adults = 500 mL = 10% TBV
- children = 8 mL/kg = 10% TBV
- reduce incidence of
- allogenic RBC transfusion
- severe postop anaemia
- specific
- JW
- cardiothoracic / vascular surgery
Contraindications3 / 7
- relative
- contamination (cancer, infection)
- however, note that circulating malignant cells are often in cancer patients, regardless of CS
- phaeochromocytoma
- patient refusal
- grossly contaminated surgical field (per manufacturer)
- especially bowel contamination = conflicting evidence
- use leucodepletion filter
- pause when non-IV-licensed substances are used
- iodine, topical clotting agents, orthopaedic cement
- sickle cell anaemia
- due to some returned RBC sickling (deformation) rate 15-50%
- result = significant haemolysis
- discsuss with haematologist on a case-by-case basis
- phaeochromocytoma (BB 2017)
- vasoactive molecules are still active on reinfusion
Risks / disadvantages4 / 7
- coagulopathy
- CS blood contains no platelets or coagulation factors
Technique / description5 / 7
- collection of shed blood from surgical field
- use minimal suction vacuum pressure ~ -100 to -150 mmHg to minimise RBC lysis
- blood is mixed with anticoagulant (heparinised saline / acid-citrate-dextrose)
- centrifugation
- separation of RBC from whole anticoagulated blood
- denser RBC forced to outer wall of bowel
- plasma moves towards centre + spills into waste bag
- wash RBC
- use NS
- pump into bag for reinfusion
- resultant Hct 50-80%
- no platelets or coagulation factors
- WBC can be removed with leucodepletion filter
- contains bacteria, fetal Hb
- amniotic fluid = fetal squamous cells mostly removed
- reinfusion
- follow manufacturers recommendation
- usually 4h after processing / 6h after start of collection
- keep at patient's bedside at all times
Common questions / related topics6 / 7
- leucodepletion filter for re-infusion
- cancer surgery
- infected surgical field
- obstetrics = mixed evidence
- SALVO trial = no significant difference