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Cell Salvage in Obstetrics.

Haley Goucher1, Cynthia A Wong, Samir K Patel

  • 1From the Department of Anesthesiology, Northwestern University, Chicago, Illinois.

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|July 22, 2015
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Summary

Intraoperative cell salvage can safely reduce the need for blood transfusions in obstetrics. Modern technology minimizes risks like amniotic fluid embolism, making cell salvage a viable option for pregnant patients.

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Area of Science:

  • Obstetric Anesthesia and Surgery
  • Transfusion Medicine
  • Patient Blood Management

Background:

  • Intraoperative cell salvage (ICS) is a method to reduce allogeneic blood transfusions.
  • Historically, ICS was contraindicated in obstetrics due to concerns about amniotic fluid embolism and maternal alloimmunization.
  • Recent technological advancements may mitigate these risks.

Purpose of the Study:

  • To evaluate the safety and feasibility of intraoperative cell salvage in the obstetric population.
  • To assess the risks associated with ICS in pregnant patients compared to the general population.
  • To determine the cost-effectiveness of ICS in specific obstetric scenarios.

Main Methods:

  • Review of current cell salvage technology and its application in obstetrics.
  • Analysis of fetal squamous cell levels in salvaged blood.
  • Examination of reported cases of amniotic fluid embolism and alloimmunization.
  • Cost-effectiveness analysis for high-transfusion-risk obstetric patients.

Main Results:

  • Fetal squamous cell levels in salvaged blood are comparable to maternal venous blood post-placental separation.
  • No definitive cases of amniotic fluid embolism linked to modern ICS equipment have been reported.
  • ICS is cost-effective for parturients with conditions like abnormal placentation, predicting high transfusion rates.

Conclusions:

  • Modern intraoperative cell salvage technology presents risks in obstetrics comparable to the general population.
  • The perceived risks of amniotic fluid embolism and alloimmunization are minimal with current equipment.
  • ICS is a safe, cost-effective strategy for reducing allogeneic blood transfusions in selected obstetric patients.