Surgical blood conservation: Blood salvage
- Michael Avidan, MD
Michael Avidan, MD
- Section Editor — Surgical Critical Care; Trauma Anesthesia
- Professor of Anesthesiology and Surgery
- Washington University School of Medicine
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
- Michele Heath, LP, CCP
Michele Heath, LP, CCP
- Durham VA Medical Center
- Section Editors
- Steven Kleinman, MD
Steven Kleinman, MD
- Section Editor — Transfusion Medicine
- Clinical Professor of Pathology
- University of British Columbia, Vancouver
- Jonathan B Mark, MD
Jonathan B Mark, MD
- Section Editor — Cardiac Anesthesiology
- Professor of Anesthesiology
- Duke University Medical Center
- Chief, Anesthesiology Service
- Veterans Affairs Medical Center
Surgical blood conservation techniques are used to reduce patient exposure to allogeneic blood during and after surgery. Techniques include preoperative autologous donation, intraoperative hemodilution, and blood salvage during surgery. This topic will review the indications, advantages, and potential complications of intraoperative blood salvage (ie, intraoperative autologous transfusion or intraoperative autotransfusion) and postoperative blood salvage.
Preoperative autologous donation and intraoperative hemodilution are discussed in detail separately. (See "Surgical blood conservation: Preoperative autologous blood donation" and "Surgical blood conservation: Intraoperative hemodilution".)
INTRAOPERATIVE BLOOD SALVAGE
We suggest intraoperative blood salvage in surgical procedures having a high likelihood of significant blood loss (>1000 mL), based on evidence that allogeneic transfusion and associated complications can be avoided .
Indications and benefits — Intraoperative blood salvage has the following potential benefits:
●Avoidance of allogeneic transfusion – The technique can be effective in avoiding or reducing allogeneic blood transfusion, with its attendant costs and risks (eg, transfusion reactions, transfusion-transmitted infections) . Thus, intraoperative blood salvage is presumed to be beneficial, although randomized trials have not demonstrated improved outcomes. In a 2010 systematic review including 75 trials (36 involving orthopedic procedures, 33 involving cardiac procedures, 6 involving vascular surgery), the absolute reduction in the use of allogeneic red blood cell transfusion was 21 percent (95% confidence interval [CI] 15-26 percent) . In a 2015 systematic review in emergency abdominal or thoracic trauma surgery (one trial; n = 44), the reduction in the use of allogeneic red blood cells in the cell salvage group was 4.7 units (95% CI 1.31-8.09 units) . These systematic reviews concluded that cell salvage did not increase the risk of adverse events, including mortality and infection [1,2]. (See "Indications and hemoglobin thresholds for red blood cell transfusion in the adult", section on 'Risks and complications of transfusion'.)
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- INTRAOPERATIVE BLOOD SALVAGE
- Indications and benefits
- - Absolute contraindications
- - Relative contraindications
- - Areas of uncertainty
- - Overview of the procedure
- - Washed versus unwashed blood
- Salvaged washed red cells
- Salvaged unwashed blood
- Storage and handling
- POSTOPERATIVE BLOOD SALVAGE
- Major orthopedic procedures
- Cardiac surgery
- POTENTIAL COMPLICATIONS
- ESTABLISHING A BLOOD SALVAGE PROGRAM
- SUMMARY AND RECOMMENDATIONS