International Journal of Obstetric Anesthesia
Volume 17, Issue 1 , Pages 37-45 , January 2008

Cell salvage in obstetrics

  • J. Allam

      Affiliations

    • Corresponding Author InformationCorrespondence to: Joanna Allam, Specialist Registrar, Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea & Westminster Hospital, 369, Fulham Road, London, SW10 9NH.
  • ,
  • M. Cox
  • ,
  • S.M. Yentis

References 

  1. Why Mothers Die. Confidential Enquiry into Maternal and Child Health 2000-2002. London: RCOG; 2004.
  2. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case control study. BMJ. 2001;322:1089–1093
  3. Catling S. Blood conservation techniques in obstetrics: a UK perspective. Int J Obstet Anesth. 2007;16:241–249
  4. Klapholz HL. Blood transfusion in contemporary obstetric practice. Obstet Gynecol. 1990;75:940–943
  5. Chief Medical Officer. Health Service Circular. Better Blood Transfusion. Appropriate use of Blood. Department of Health, July 2002.
  6. Sloan NL, Jordan E, Winikoff B. Effects of iron supplementation on maternal hematologic status in pregnancy. Am J Public Health. 2002;92:288–293
  7. Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. Cochrane Database Syst Rev. 2006;3:CD004736
  8. Vamvakas EC. Transfusion-associated cancer recurrence and postoperative infection: Meta-analysis of randomised, controlled clinical trials. Transfusion. 1996;36:175–186
  9. McClelland D B L. Handbook of Transfusion Medicine. United Kingdom Blood Services. London: TSO; 2007: 59–62.
  10. Sloand EM, Pitt E, Klein HG. Safety of the blood supply. JAMA. 1995;274:1368–1373
  11. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine: first of two parts – blood transfusion. N Engl J Med. 1999;340:438–447
  12. Klein HG. Immunomodulatory aspects of transfusion. Anesthesiology. 1999;91:861–865
  13. SHOT (Serious Hazards of Transfusion). www.shot-uk.org.
  14. Goodnough LT, Shander A, Brecher ME. Transfusion medicine: looking to the future. Lancet. 2003;361:161–169
  15. Blackbourn DJ, Ambroziak J, Lennette E, Adams M, Ramachandran B, Levy JA. Infectious human herpesvirus 8 in a healthy North American blood donor. Lancet. 1997;349:609–611
  16. Simmonds P. Transfusion virology: progress and challenges. Blood Rev. 1998;12:171–177
  17. Llewelyn CA, Hewitt PE, Knight RSG, et al. Possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion. Lancet. 2004;363:417–421
  18. Peden AH, Head MW, Ritchie DL, Bell JE, Ironside JW. Preclinical vCJD after blood transfusion in a PRNP codon129 heterozygous patient. Lancet. 2004;364:527–529
  19. Wroe SJ, Pal S, Siddique D, et al. Clinical presentation and pre-mortem diagnosis of variant Creutzfeldt-Jakob disease associated with blood transfusion: a case report. Lancet. 2006;368:2061–2067
  20. HPA (Health Protection Agency). www.hpa.org.uk.
  21. Ironside JW. Variant Creutzfeldt-Jakob disease: risk of transmission by blood transfusion and blood therapies. Haemophilia. 2006;12:8–15
  22. Spahn DR, Casutt M. Eliminating blood transfusions. New aspects and perspectives. Anesthesiology. 2000;93:242–255
  23. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine: second of two parts – blood conservation. N Engl J Med. 1999;340:525–533
  24. Herbert WNP, Owen HG, Collins ML. Autologous blood storage in obstetrics. Obstet Gynecol. 1988;72:166–170
  25. McVay PA, Hoag RW, Toy PTCY. Safety and use of autologous blood donation during the third trimester of pregnancy. Am J Obstet Gynecol. 1989;160:1479–1488
  26. Catling SJ, Freites O, Krishnan S, Gibbs R. Clinical experience with cell salvage in obstetrics: 4 cases from one UK centre. Int J Obstet Anesth. 2002;11:128–134
  27. OAA/AAGBI Guidelines for Obstetric Anaesthetic Services. Revised Edition: OAA/AAGBI; London: May 2005: 25.
  28. Tawes RL. The basic concepts of an autotransfusor: the cell saver. Semin Vasc Surg. 1994;7:93–94
  29. Tawes RL. Clinical application of autotransfusion. Semin Vasc Surg. 1994;7:89–90
  30. Booke M, Fobker M, Fingerhut D, Storm M, Mortlemans Y, Van Aken H. Fat elimination during intraoperative autotransfusion: An in vitro investigation. Anesth Analg. 1997;85:959–962
  31. Orr M D, Blenko J W. Autotransfusion of concentrated washed red cells from the surgical fields: a biochemical and physiological comparison of homologous cell transfusion. Proceeding of Blood Conservation Institute 1978; 116–28.
  32. McShane AJ, Power C, Jackson JF, et al. Autotransfusion: Quality of blood prepared with a red cell processing device. Br J Anaesth. 1987;59:1035–1039
  33. Serrick CJ, Scholz M, Melo A, Singh O, Noel D. Quality of red blood cells using autotransfusion devices: a comparative analysis. J Extra Corpor Technol. 2003;35:28–34
  34. Geiger P, Platow K, Bartl A, Volk C, Junker K, Mehrkens HH. New developments in autologous transfusion systems. Anaesthesia 1998; 53 Suppl 2: 32–5.
  35. Duffy G, Tolley K. Cost analysis of autologous blood transfusion, using cell salvage, compared with allogenic blood transfusion. Transfus Med. 1997;7:189–196
  36. Huet C, Salmi LR, Fergusson D, Koopman-van Gemert AW, Rubens F, Laupacis A. International Study of Perioperative Transfusion (ISPOT) Investigators: A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopaedic surgery. Anesth Analg. 1999;89:861–869
  37. Carless PA, Henry DA, Moxey AJ, O’Connell DL, Brown T, Fergusson DA. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews 2006: CD001888.
  38. Waters JH, Sprung J. Errors during intraoperative cell salvage because of inappropriate wash solutions. Anesth Analg. 2001;93:1483–1485
  39. Clarke JMF. Surgery in Jehovah’s Witnesses. Br J Hosp Med. 1982;27:497–500
  40. Waters JH, Potter PS. Cell salvage in the Jehovah’s Witness patient. Anesth Analg. 2000;90:229
  41. Mattox KL. Comparison of techniques of autotransfusion. Surgery. 1978;84:700–702
  42. Sharp WV, Stark M, Donovan DL. Modern autotransfusion. Experience with a washed red cell processing technique. Am J Surg. 1981;142:522–524
  43. Linden JV, Kaplan HS, Murphy MT. Fatal air embolism due to perioperative blood recovery. Anesth Analg. 1997;84:422–426
  44. Schwieger IM, Gallagher CJ, Finlayson DC, et al. Incidence of cell-saver contamination during cardiopulmonary bypass. Ann Thorac Surg. 1989;48:51–53
  45. Connall TP, Zhang J, Vaziri ND, et al. Leukocyte CD11b and CD18 expression are increased in blood salvaged for autotransfusion. Am Surg. 1994;60:797–800
  46. Sieunarine K, Lawrence-Brown MM, Goodman MA, et al. Plasma levels of the lipid mediators, leukotriene B4 and lyso platelet-activating factor, in intraoperative salvaged blood. Vox Sang. 1992;63:168–171
  47. Bull S, Bull MH. The salvaged blood syndrome: a sequel to mechanochemical activation of platelets and leukocytes?. Blood Cells Mol Dis. 1990;16:215–223
  48. Tawes RL, Duvall TB. Is the “salvaged-cell syndrome” myth or reality?. Am J Surg. 1996;172:172–174
  49. Innerhofer P, Wiedermann F, Tiefenthaler W, et al. Are leukocytes in salvaged washed autologous blood harmful for the recipient? The results of a pilot study. Anesth Analg. 2001;93:566–572
  50. Steiner PE, Lushbaugh CC. Maternal pulmonary embolism by amniotic fluid as a cause of obstetric shock and unexpected deaths in obstetrics. JAMA. 1941;117:1245 and 1340
  51. Morgan M. Amniotic fluid embolism. Anaesthesia. 1979;34:20–32
  52. Tufnell DJ. United Kingdom amniotic fluid embolism register. Br J Obstet Gynaecol. 2005;112:1625–1629
  53. Lewis TLT. Progress in Clinical Obstetrics and Gynaecology. 2nd ed.. London: Churchill; 1964;48
  54. Halmagyi DFJ, Starzecki B, Shearman RP. Experimental amniotic fluid embolism: mechanism and treatment. Am J Obstet Gynecol. 1962;84:251
  55. Attwood HD, Downing SE. Experimental amniotic fluid and meconium embolism. Surg Gynecol Obstet. 1965;120:255
  56. Clark SL, Hankins DV, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: analysis of the National Registry. Am J Obstet Gynecol. 1995;172:1158–1169
  57. Clarke SL, Pavlova A, Greenspoon J, Horenstein J, Phelan JP. Squamous cells in the maternal pulmonary circulation. Am J Obstet Gynecol. 1986;154:104–106
  58. Kuhlman K, Hidvegi D, Tamura RK, et al. Is amniotic fluid material in the central circulation of peripartum patients pathologic?. Am J Perinatol. 1985;2:295–299
  59. Yentis SM. Sudden obstetric collapse syndrome. Int J Obstet Anesth. 1999;8:296
  60. Zichella L, Gramolini R. Autotransfusion during cesarean section. Am J Obstet Gynecol. 1990;162:295
  61. Thornhill ML, O’Leary AJ, Lussos SA, Rutherford C, Johnson MD. An in-vitro assessment of amniotic fluid removal from human blood through cell saver processing. Anesthesiology. 1991;75:A830
  62. Fong J, Gurewitcsh ED, Kump L, Klein R. Clearance of fetal products and subsequent immunoreactivity of blood salvaged at cesarean delivery. Obstet Gynecol. 1999;93:968–972
  63. Lockwood CJ, Bach R, Guha A, et al. Amniotic fluid contains tissue factor, a potent initiator of coagulation. Am J Obstet Gynecol. 1991;165:1335–1341
  64. Fuhrer Y, Bayoumeu F, Boileau S, Dousset B, Foliguet B, Laxenaire MC. Evaluation of the blood quality collected by cell-saver during cesarean section. Ann Fr Anesth Reanim. 1996;15:1162–1167
  65. Bernstein HH, Rosenblatt MA, Gettes M, Lockwood C. 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
  66. Henn-Beilharz C, Krier C. Re-transfusion in bone surgery: what happens to the fat?. Anaesthesiol Intensivmed Notfallmed Schmerzther. 1991;26:224–225
  67. Dzik S. Leukodepletion blood filters: Filter design and mechanisms of leukocyte removal. Transfus Med Rev. 1993;7:65–77
  68. Edelman MJ, Potter P, Mahaffey KG, Frink R, Leidich RB. The potential for reintroduction of tumor cells during intraoperative blood salvage: Reduction of risk with use of the RC-400 leukocyte depletion filter. Urology. 1996;47:179–181
  69. Kongsgaard UE, Wang MY, Kvalheim G. Leucocyte depletion filter removes cancer cells in human blood. Acta Anaesthesiol Scand. 1996;40:118–120
  70. Thomas MJG. Infected and malignant fields are an absolute contraindication to intraoperative cell salvage: fact or fiction?. Transfus Med. 1999;9:269–278
  71. Ezzedine H, Baele P, Robert A. Bacteriologic quality of operative autotransfusion. Surgery. 1991;109:259–264
  72. Ozmen V, McSwain NE, Nichols RL, Smith J, Flint LM. Autotransfusion of potentially culture-positive blood (CPB) in abdominal trauma: preliminary data from a prospective study. J Trauma. 1992;32:36–39
  73. Rainaldi MP, Tazzari PL, Scagliarini G, Borghi B, Conte R. Blood salvage during caesarean section. Br J Anaesth. 1998;80:195–198
  74. Durand F, Duchesne-Gueguen M, Le Bervet JY, et al. Rheologic and cytologic study of autologous blood collected with Cell Saver 4 during caesarean. Rev Fr Transfus Hemobiol. 1989;32:179–191
  75. Waters JH, Biscotti C, Potter PS, Phillipson E. Amniotic fluid removal during cell salvage in the cesarean section patient. Anesthesiology. 2000;92:1519–1522
  76. Munoz-Gomez M, Romero Ruiz A, Ariza Villanueva D, et al. [Ability of leukocyte reduction filters to remove fat particles from blood in experimental models simulating blood salvage in orthopedic surgery]. Rev Esp Anestesiol Reanim 2005; 52: 81–7.
  77. Catling SJ, Williams S, Fielding AM. 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
  78. Papageorgiades G. Transplacental passage of fetal red cells into the maternal circulation. In normal, abnormal, and instrumental deliveries. Clin Pediatr (Phila). 1976;15:42–43
  79. Lostumbo MM, Holland PV, Schmidt PJ. Isoimmunisation after multiple transfusions. N Engl J Med. 1966;275:141–144
  80. Cunningham FG, MacDonald PC, Gant NF, et al. Diseases and injuries of the fetus and newborn. 20th ed.. Williams Obstetrics. Stamford: Appleton and Lange; 1997;967–1008
  81. Freischlag JA. Intraoperative blood salvage in vascular surgery – worth the effort?. Crit Care. 2004;8:S53–S56
  82. Alvarez GG, Fergusson DA, Neilipovitz DT, Hebert PC. Cell salvage does not minimize perioperative allogeneic blood transfusion in abdominal vascular surgery: a systematic review. Can J Anesth. 2004;51:425–431
  83. Keeling MM, Gray LA, Brink MA, Hillerick VK, Bland KI. Intraoperative autotransfusion: Experience in 725 consecutive cases. Ann Surg. 1983;197:536–541
  84. Merrill BS, Mitts DL, Rogers W, Weinberg PC. Autotransfusion intraoperative use in ruptured ectopic pregnancy. J Reprod Med. 1980;24:14–16
  85. Yamada T, Okamoto Y, Kasamatsu H, Mori H. Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery. J Soc Laparoendosc Surg. 2003;7:97–100
  86. Catling S, Joels L. Cell salvage in obstetrics: the time has come. Br J Obstet Gynaecol. 2005;112:131–132
  87. Jackson SH, Lonser RE. Safety and effectiveness of intracesarean blood salvage. Transfusion. 1993;33:181
  88. Rebarber A, Lonser R, Jackson S, Copel JA, Sipes S. The safety of intraoperative autologous blood collection and autotransfusion during cesarean section. Am J Obstet Gynecol. 1998;179:715–720
  89. O’Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol. 1996;175:1632–1638
  90. Potter PS, Waters JH, Burger GA, Mraovic B. Application of cell salvage during cesarean section. Anesthesiology. 1999;90:619–621
  91. de Souza A, Permezel M, Anderson M, Ross A, McMillan J, Walker S. Antenatal erythropoietin and intra-operative cell salvage in a Jehovah’s Witness with placenta praevia. Br J Obstet Gynaecol. 2003;110:524–526
  92. Oei SG, Wingen CBM, Kerkkamp HEM. Cell salvage: how safe in obstetrics?. Int J Obstet Anesth. 2000;9:143
  93. Grimes DA. A simplified device for intraoperative autotransfusion. Obstet Gynecol. 1988;72:947–950
  94. Waters JH, Lukauskiene E, Anderson ME. Intraoperative blood salvage during cesarean delivery in a patient with beta thalassemia intermedia. Anesth Analg. 2003;97:1808–1809
  95. Boonstra JG, Overbeeke MA, de Rijke YB, Duvekot JJ. A pregnant woman with irregular erythrocyte antibodies for whom no compatible packed red blood cells were available. Ned Tijdschr Geneeskd. 2005;149:2613–2618
  96. ACOG Committee opinion. Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists. Int J Gynecol Obstet 2002; 77: 77–78.
  97. National Institute for Health and Clinical Excellence. Intraoperative blood cell salvage in obstetrics. Interventional Procedure Guidance 144. November 2005, 1.1–2.4.3.
  98. Weiskopf RB. Erythrocyte salvage during cesarean section. Anesthesiology. 2000;92:1519–1522
  99. Camann W. Cell salvage during cesarean delivery: is it safe and valuable? Maybe, maybe not!. Int J Obstet Anesth. 1999;8:75–76
  100. Waters JH (proposer), Santrach PJ (opposer). Is cell salvage a safe technique for the obstetric patient? Society for Obstetric Anesthesia and Perinatology (SOAP) Newsletter, Fall 2005: 7–9.
  101. Thomas D (proposer), Clark V (opposer). Facilities for blood salvage (cell saver technique) must be available in every obstetric theatre. Int J Obstet Anesth 2005; 14: 48–52.
  102. McCheyne J, Arfeen Z, Evans P, Misra U. Massive obstetric haemorrhage: a survey of obstetric units in the UK. Int J Obstet Anesth. 2005;14:S6

PII: S0959-289X(07)00158-6

doi: 10.1016/j.ijoa.2007.08.001

International Journal of Obstetric Anesthesia
Volume 17, Issue 1 , Pages 37-45 , January 2008