What is intraoperative autotransfusion with cell salvage?

Updated: Apr 16, 2019
  • Author: Linda L Maerz, MD, FACS, FCCM; Chief Editor: Emmanuel C Besa, MD  more...
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Cell salvage is an effective method of transfusion avoidance. Shed blood is collected from the operative field and mixed with an anticoagulant. It is concentrated and washed or filtered, then returned to the patient. Harmful contaminants, such as potassium, fat, and free hemoglobin, are removed from the salvaged blood; the washed blood is returned via a 40-µm blood filter. Blood obtained from the thoracic cavity via chest tubes in a closed system can be processed and autotransfused in a similar manner. However, this is much less frequently done. 

Relative contraindications to cell salvage include the following: malignancy, bacterial contamination of the surgical site, cesarean delivery, and sickle cell disease. However, improvements in processing, particularly the use of leukocyte-depletion filters, have made cell salvage possible in anecdotal cases complicated by the contraindications described above and are supported by in vitro data. Nonetheless, most practitioners still hew to the existing guidelines for the use of scavenged blood. [67]

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