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[Evaluation of the blood quality collected by cell-saver during cesarean section]
Y Fuhrer1, F Bayoumeu, S Boileau
1Service d'anesthésie-réanimation chirurgicale, maternité régionale, Nancy, France.
Objective:
To determine the quality of blood salvaged and processed during Caesarean section with a cell-saver.
Study Design:
Laboratory study.
Patients:
The study included 20 patients of ASA physical class 1 or 2 undergoing a scheduled Caesarean section.
Methods:
A separate suction device was used from the beginning surgery until the delivery of the fetus, to remove most of the amniotic fluid coming from the surgical field. Thereafter using an Haemolite 2Plus (Haemonetics), the blood was separated and washed with 2 L of normal saline solution. Blood quality was assessed through detection of fetal cells and measuring out of alpha-fetal-protein, tissue factor. A Kleihauer test was also performed.
Results:
Cell-saver processing removed most of alpha-fetal-protein and tissue factor while fetal cells were rarely seen. The Kleihauer test could not be performed because of haemolized blood samples. However, the results were very heterogeneous and after washing some salvaged units contained very high concentrations of alpha-fetal-protein or tissue factor.
Conclusions:
These preliminary results show that intra-operative autologous transfusion is not fully safe during Caesarean sections. In addition, there is an immunological risk if a significant part of fetal red blood cells are reinfused into maternal circulation. Therefore, additional studies are needed to better assess this risk.