FOR INTRA-OPERATIVE BLOOD SALVAGE
Current risks and poorly defined benefits will continue to be problems
associated with blood transfusions. Infectious complications, immunological
events, and a suggestion of increased mortality all pose as a threat to
transfusion recipients, along with blood shortages and the rising cost
of blood incurred by the increasingly advanced hemovigilance techniques.
The mechanisms leading to the largely unfavourable outcomes of transfusion
therapy remain unclear. Current thinking points to several possibilities,
including the effects of storage lesions in stored red blood cells (RBC’s),
the long-term persistence of donor leukocytes in the recipient circulation,
or a combination of both. Whatever the cause of transfusion-related complications,
the increasingly unfavourable safety profile with transfused blood has
led to a global movement to minimize the inappropriate use of allogeneic
blood and blood products. Although the quest for “blood substitutes:
is ongoing, none have attained clinical significance. In the meantime,
employing blood conservation techniques is no longer an option but a vital
Intra-operative blood salvage with intra-operative auto-transfusion is
an important and commonly used blood conservation technique in spinal
With this technique, blood lost during surgery is recuperated and processed
through a pump system (Cell Saver) then transfused back to the patient.
In this case it is scavenged blood that returns to the patient. It does
not contain platelets or coagulation factors. This requires a system that
suctions the wound, separates the RBC’s from the other blood products
and debris, washes the RBC’s, and returns them to the patient. It
is estimated that about half of the lost red blood cells can be salvaged
The main complication is that a dilutional or disseminated coagulopathy
can occur, and there is also a question about the complete elimination
of tissue residues. Cell saving is therefore contraindicated in the presence
of coagulopathies. Other rare complications include pulmonary injuries
probably linked to leukoagglutinins (2) and transient hemoglobinuria (1).
The technique has been reported to be effective in spine surgery (3,
4, 5). In a meta-analysis, Huet et al. (6) concluded that cell salvage
in orthopaedic surgery decreases the frequency of allogeneic transfusions,
and a recent Cochrane review on cell salvage the poor methodological quality
of most studies (7).
1. Flynn JC, Metzger CT, Csencsitz TA (1982) Intraoperative autotransfusion
(IAT) in spinal surgery. Spine 7:432-435.
2. Walker R (1987) Special report: transfusion risks. AM J Clin Pathol
3. Behrman MJ, Keim HA (1992) Perioperative red blood cell salvage in
spine surgery. A prospective analysis. Clin Orthop 278:51-57.
4. Lennon RK, Hosking MP, Gray JR, Klassen RA, Popovsky MA, Warner MA
(1987). The effects of intraoperative blood salvage and induced hypotension
on transfusion requirements during spinal surgical procedures. Mayo Clin
5. Mandel RT, Brown MD, McCollough NC 3rd, Pallares V, Varlotta R (1981).
Hypotensive anaesthesia and autotransfusion in spinal surgery Clin Orthop
6. Huet C, Salmi LR, Ferguson D, Koopman-van Gemert AW, Rubens F, Laupacis
A (1999) A meta-analysis of the effectiveness of cell salvage to minimize
perioperative allogeneic blood transfusion in cardiac and orthopaedic
surgery. International Study of Perioperative Transfusion (ISPOT) Investigators.
Anesth Analg 89:861-869.
7. Carless PA, Henry DA, Moxey AJ, O’Connell DL, Ferguson DA (2004)
Cell salvage for minimising perioperative allogeneic blood transfusion.
IN: The Cochrane Library Issue 1. Wiley, London
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