A balanced view on intra- and postoperative blood salvage

Increasing fear of transfusion related HIV infection, due to recent problems in West European countries, could result in an exaggerated confidence in autologous transfusion techniques. The author, being an anesthesiologist working in a blood bank since one year, tries to put forward a balanced opinion. After a short historical overview, the three main groups of blood salvage techniques are presented: intraoperative blood salvage without and with cell washing as well as postoperative salvage. For each group the following items are discussed: careful technique, quality of the autologous blood, indications, side effects, limitations, efficiency and cost. It is demonstrated that blood salvaging is not the first choice in a global blood sparing and safety program. Some sort of routine quality control should be instituted and if necessary (the safest possible) homologous blood should be preferred. Finally, a practical proposal for elective surgery is roughly made, stressing the life saving potential of blood salvaging in emergency situations.