Cell salvage
Autologous cell salvage offers a way to minimize allogenic red blood cell transfusion in select patients, such as those with high risk of massive obstetric hemorrhage, low preoperative hemoglobin concentrations, rare blood types (e.g. Bombay), and/or those who refuse such products including Jehovah’s witnesses.
Whilst cell salvage and retransfusion are viewed as relatively expensive and labor intensive, autologous cell salvage is now being adopted in many obstetric centers managing PAS disorders, with observational studies showing improved outcomes and reduced need for allogenic blood transfusion, without an increase in adverse outcomes.
Regarding cost analysis, a recent study demonstrated that intraoperative cell salvage during cesarean delivery for invasive placentation justified its use where the probability of requiring packed red cell transfusion of two units was 75%.
It is important that suctioned contaminants are kept to an absolute minimum, including amniotic fluid, vernix, microorganisms, fetal blood, and exogenous surgical solutions such as contemporary hemostatics. These may not be filtered adequately by cell salvage equipment and may be reinfused directly into the maternal circulation with theoretical complications including embolism, isoimmunization and thrombosis.