Postoperative Salvage: Technological Advance in the "Washed vs Unwashed" Blood Controversy

In the past decade, the standard of care for transfusion in major surgery has evolved in most modern hospitals to auto transfusion (AT) techniques. In several states, in fact, it has become a law of "informed consent". The surgeon must present the risks of homologous transfusion and discuss alternatives and options with the patient. Presently, three standard transfusion options are preoperative donation, intraoperative salvage, and postoperative salvage. This article will address aspects of the latter option - post-operative salvage. Present technology has made significant advances over older collection systems. The Haemolite® 2 is a compact, portable cell-saver well-suited for this purpose for reasons to be presented. Postoperative blood salvage is not a new concept. The Sorenson Device (Sorenson Research Co., Salt Lake City, UT) has been used extensively for many years to collect blood from mediastinal and chest tubes following cardiovascular and thoracic surgery. Similarly, the Soleotrans collection device (Solco-Basle, Rockland, Mass) has been used in vascular and orthopedic cases for blood salvage. Other devices such as the Pleura-Vac and Auto-Vac share the same features: collection of shed blood in low volume, filtration, and reinfusion without washing the RBC's. (Figure I) The omission of this processing step is the major difference in comparison with the Haemolite® 2 that separates the RBC's by centrifugal washing. (Figure 2) Presently this "washed vs unwashed" aspect is the source of controversy, which this article will attempt to clarify.