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Intraoperative cell salvage as part of a blood conservation strategy in an obstetric population with abnormal placentation at a large Irish tertiary referral centre: an observational study

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Abstract

Background

Haemorrhagic morbidity is more common in women with abnormal placentation, that is placenta praevia or morbidly adherent placenta. The incidence of abnormal placentation is increasing due to rising caesarean section rates. Concerns regarding blood safety, blood shortages and soaring costs of blood processing have generated growing enthusiasm for blood conservation strategies. The aim of our study was to look at intraoperative cell salvage (IOCS) use and allogeneic transfusion patterns in patients with abnormal placentation.

Methods

Patients with abnormal placentation were identified from the hospital database over a 2-year period between 2015 and 2016. Information collected for those that had IOCS setup included estimated blood loss, volume of blood collected and returned, pre- and postoperative haemoglobin levels and use of allogeneic blood.

Results

A total of 139 cases of abnormal placentation were identified. Abnormal placentation accounted for 62% of all cases of IOCS usage and was established for 53 patients with abnormal placentation. The re-transfusion rate was 18.5%. Five patients received IOCS blood only. The allogeneic transfusion rate was 7.5% in patients who had IOCS setup compared with 6.9% in those who did not (p = 1.00). Median blood loss was greater for patients who had IOCS blood returned compared with patients who had not (p = 0.004). The median volume of blood returned was 520 (114–608) mL. Preoperative haemoglobin levels were lower for patients who received a combination of cell salvage and allogeneic blood (p = 0.006).

Conclusions

IOCS contributed to a reduction or elimination of allogeneic transfusion for a proportion of this high-risk cohort and should be an integral component of a hospitals’ blood conservation strategy.

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Acknowledgements

We would like to acknowledge Mr. Colin Kirkham, research officer at the Rotunda Hospital for his assistance with the statistical analysis involved in the study.

Contribution to authorship

DOF conceived the idea of this study, contributed to study design, performed data collection, performed the data analysis and interpretation and prepared the manuscript. SE reviewed the study design, contributed to data collection, data analysis and interpretation and review of manuscript. FNA contributed to interpretation of data and revised the manuscript for important intellectual content. NH conceived the idea of the study, contributed significantly to study design, contributed to data extraction and interpretation and preparation of the manuscript including revision for important intellectual content. All authors approved the final version of the manuscript and accept responsibility for the paper.

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Authors and Affiliations

  1. Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland

    Doireann O’Flaherty & Niamh Hayes

  2. Department of Haemovigilence, The Rotunda Hospital, Dublin, Ireland

    Siobhan Enright

  3. Department of Haematology, The Rotunda Hospital, Dublin, Ireland

    Fionnuala Ní Ainle

  4. Mater Misericordiae University Hospital, Eccles St, Dublin, Ireland

    Fionnuala Ní Ainle & Niamh Hayes

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  1. Doireann O’Flaherty
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Correspondence to Doireann O’Flaherty.

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Approval was obtained from the Rotunda Hospitals’ ethics committee on the 26th January 2016 (reference 16-020).

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O’Flaherty, D., Enright, S., Ainle, F.N. et al. Intraoperative cell salvage as part of a blood conservation strategy in an obstetric population with abnormal placentation at a large Irish tertiary referral centre: an observational study. Ir J Med Sci 189, 1053–1060 (2020). https://doi.org/10.1007/s11845-020-02182-x

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