• Cell salvage
    • Cells are collected, filtered and washed before being transfused back
    • Platelets, WBC, plasma, heparin and inflammatory mediators are discarded in the wash
    • The RBCs in saline have a Hct of 40-70
    • The machine must be used within 8 hrs
    • Controversies
      • Sickle cell disease
        • Not recommended by manufactures but has been used with some success in trait only
      • Cancer surgery
        • Use not recommended as possible rein fusion of cancer cells
        • Use in urological cancers approved by NICE if leukodepletion filter is used
      • Bowel surgery
        • Ok if commenced after initial decontamination with ABx used
      • Obstetrics
        • No cases of AFE reported. Separate suction used for amniotic fluid and blood given back via a leukodepletion filter.
    • Procedure
      • Low pressure suction <150mmHg
      • Swabs can be washed
      • Separate suction for betadine, cement, pleural effusions, pancreatic secretions etc.
      • Avoid surface skimming to prevent haemolysis
      • Heparin is usually 30 000 units in 1L of saline at a rate of 60-80 drops per minute
      • Blood is sucked via a dual lumen tube and is mixed with anticoagulant in a reservoir
      • The reservoir has a filter of 40-150μcm
      • Separation is via the centrifuge bowl
      • Photo-optics detect the buffy coat and are disposed of in a clinical waste bag
      • The RBCs are then stored in a separate bag and reinfused up to 4 hrs after processing
      • Blood should be labelled appropriately
    • Processing details
      • Fixed bowl systems (sizes 55ml-500ml)
      • Variable volume disk systems
      • Continuous rotary systems
        • Washing and processing takes place continuously with minimal wastage
    • Post-op cell salvage
      • Collection of blood from drains and reinfusion within 6 hrs is recommended
      • Vacuum operated systems prevent haematoma and haemolysis
      • It must be filled before being returned to the patient (washing optional)
    • Indications
      • Anticipated blood loss > 1L
      • Pre-op anaemia
      • Rare blood groups or antibodies
      • Refusal for allogenic blood transfusion
    • Complications
      • Electrolyte imbalances
      • Air embolism
      • Pyrexia
      • Microembiolism
      • Fat embolism
      • Haemolysis and free Hb
      • Coagulopathy
    • Specific indications
      • JW
        • Some allow cell salvage
      • Cardiothoracic
        • Most use cell salvage for complex procedures and off pump surgery
      • Ortho
        • Joint revisions
      • Paediatrics
        • Uses continuous processing rather than fixed volume bowl.
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/10/4/104.full.pdf