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Clinical Utility of Autologous Salvaged Blood: a Review

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Autologous salvaged blood, commonly referred to as “cell saver” or “cell salvage” blood, is an important method of blood conservation. Understanding the mechanism of action and summarizing the existing evidence regarding the safety, efficiency, and the relative costs of cell salvage may help educate clinicians on how and when to best utilize autotransfusion.

Methods

This review focuses on issues concerning the quality of red blood cells (RBC), efficiency, and the cost effectiveness relative to autotransfusion. The key considerations of safe use and clinical applicability are described along with the challenges for wider dissemination.

Results

Cell salvage can reduce requirements for allogeneic transfusions, along with the associated risks and costs. Autologous salvaged RBCs provide high-quality transfusion, since the cells have not been subjected to the adverse effects of storage as occurs with banked blood. The risks for RBC alloimmunization and transfusion-related infectious diseases are also avoided. With a careful selection of cases, salvaged blood can be more cost effective than donor blood. Cell salvage may have a role in cardiac, major vascular, orthopedic, transplant, and trauma surgeries. However, there remain theoretical safety concerns in cases with bacterial contamination or in cancer surgery.

Conclusion

In addition to other methods of blood conservation used in patient blood management programs, autologous salvaged blood adds value and is cost effective for appropriate surgical cases. Evidence suggests that autologous salvaged blood may be of higher quality and confer a cost reduction compared with the allogeneic banked blood, when used appropriately.

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References

  1. Dodd RY. Emerging pathogens and their implications for the blood supply and transfusion transmitted infections. British journal of haematology. 2012;159(2):135–142.

    PubMed  Google Scholar 

  2. Carson JL, Triulzi DJ, Ness PM. Indications for and adverse effects of red-cell transfusion. N Engl J Med. 2017;377(13):1261–1272.

    PubMed  Google Scholar 

  3. Sadana D, Pratzer A, Scher LJ, et al. Promoting high-value practice by reducing unnecessary transfusions with a patient blood management program. JAMA Intern Med. 2018;178(1):116–122.

    PubMed  Google Scholar 

  4. Halsted WS. Reinfusion in carbonic oxide poisoning. NY Med J. 1883.

  5. Wilson JD, Taswell HF. Autotransfusion: Historical review and preliminary report on a new method. Mayo Clinic proceedings. 1968;43(1):26–35.

    CAS  PubMed  Google Scholar 

  6. Sikorski RA, Rizkalla NA, Yang WW, Frank SM. Autologous blood salvage in the era of patient blood management. Vox sanguinis. 2017;112:499–510.

    CAS  PubMed  Google Scholar 

  7. Scott AV, Nagababu E, Johnson DJ, et al. 2,3-Diphosphoglycerate concentrations in autologous salvaged versus stored red blood cells and in surgical patients after transfusion. Anesth Analg. 2016;122(3):616–623.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Heaton A, Keegan T, Holme S. In vivo regeneration of red cell 2,3-diphosphoglycerate following transfusion of DPG-depleted AS-1, AS-3 and CPDA-1 red cells. British journal of haematology. 1989;71(1):131–136.

    CAS  PubMed  Google Scholar 

  9. Baskurt OK, Meiselman HJ. Blood rheology and hemodynamics. Semin Thromb Hemost. 2003;29(5):435–450.

    CAS  PubMed  Google Scholar 

  10. Frank SM, Abazyan B, Ono M, et al. Decreased erythrocyte deformability after transfusion and the effects of erythrocyte storage duration. Anesth Analg. 2013;116(5):975–981.

    PubMed  PubMed Central  Google Scholar 

  11. Salaria ON, Barodka VM, Hogue CW, et al. Impaired red blood cell deformability after transfusion of stored allogeneic blood but not autologous salvaged blood in cardiac surgery patients. Anesth Analg. 2014;118(6):1179–1187.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Tinmouth A, Chin-Yee I. The clinical consequences of the red cell storage lesion. Transfus Med Rev. 2001;15(2):91–107.

    CAS  PubMed  Google Scholar 

  13. Yazer MH, Waters JH, Elkin KR, Rohrbaugh ME, Kameneva MV. A comparison of hemolysis and red cell mechanical fragility in blood collected with different cell salvage suction devices. Transfusion. 2008;48(6):1188–1191.

    PubMed  Google Scholar 

  14. Waters JH, Williams B, Yazer MH, Kameneva MV. Modification of suction-induced hemolysis during cell salvage. Anesth Analg. 2007;104(3):684–687.

    PubMed  Google Scholar 

  15. Sistino JJ, Owitz D, Mongero LB. Heparin washout in the pediatric Cell Saver bowl. The journal of extra-corporeal technology. 1992;24(3):94–96.

    CAS  PubMed  Google Scholar 

  16. Kling D, Borner U, von Bormann B, Hempelmann G. [Heparin elimination and free hemoglobin following cell separation and washing of autologous blood with Cell Saver 4]. Anasth Intensivther Notfallmed. 1988;23(2):88–90.

    CAS  PubMed  Google Scholar 

  17. Gravlee GP, Hopkins MB, Yetter CR, Buss DH. Heparin content of washed red blood cells from the cardiopulmonary bypass circuit. J Cardiothorac Vasc Anesth. 1992;6(2):140–142.

    CAS  PubMed  Google Scholar 

  18. Paravicini D, Schmitz-Huebner U, Stinnesbeck B. [Heparin elimination in intraoperative autotransfusion with the haemonetics cell saver]. Infusionstherapie und klinische Ernahrung. 1983;10(1):19–21.

    CAS  PubMed  Google Scholar 

  19. Waters JH, Lee JS, Karafa MT. A mathematical model of cell salvage efficiency. Anesth Analg. 2002;95(5):1312–1317, table of contents.

    Google Scholar 

  20. Haynes SL, Bennett JR, Torella F, McCollum CN. Does washing swabs increase the efficiency of red cell recovery by cell salvage in aortic surgery? Vox sanguinis. 2005;88(4):244–248.

    CAS  PubMed  Google Scholar 

  21. Carless PA, Henry DA, Moxey AJ, O’Connell D, Brown T, Fergusson DA. Cell salvage for minimising perioperative allogeneic blood transfusion. The Cochrane database of systematic reviews. 2010(4):CD001888.

    Google Scholar 

  22. So-Osman C, Nelissen RG, Koopman-van Gemert AW, et al. Patient blood management in elective total hip- and knee-replacement surgery (Part 1): A randomized controlled trial on erythropoietin and blood salvage as transfusion alternatives using a restrictive transfusion policy in erythropoietin-eligible patients. Anesthesiology. 2014;120(4):839–851.

    CAS  PubMed  Google Scholar 

  23. So-Osman C, Nelissen RG, Koopman-van Gemert AW, et al. Patient blood management in elective total hip- and knee-replacement surgery (part 2): A randomized controlled trial on blood salvage as transfusion alternative using a restrictive transfusion policy in patients with a preoperative hemoglobin above 13 g/dl. Anesthesiology. 2014;120(4):852–860.

    CAS  PubMed  Google Scholar 

  24. van Bodegom-Vos L, Voorn VM, So-Osman C, et al. Cell salvage in hip and knee arthroplasty: A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2015;97(12):1012–1021.

    PubMed  Google Scholar 

  25. Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365(26):2453–2462.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med. 2017;377(22):2133–2144.

    PubMed  Google Scholar 

  27. Murphy GJ, Pike K, Rogers CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med. 2015;372(11):997–1008.

    CAS  PubMed  Google Scholar 

  28. Robertson CS, Hannay HJ, Yamal JM, et al. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: A randomized clinical trial. Jama. 2014;312(1):36–47.

    PubMed  PubMed Central  Google Scholar 

  29. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. New Engl J Med. 2013;368(1):11–21.

    CAS  PubMed  Google Scholar 

  30. Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. 2014;371(15):1381–1391.

    PubMed  Google Scholar 

  31. Hajjar LA, Vincent JL, Galas FR, et al. Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial. Jama. 2010;304(14):1559–1567.

    CAS  PubMed  Google Scholar 

  32. Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340(6):409–417.

    CAS  PubMed  Google Scholar 

  33. Lacroix J, Hebert PC, Hutchison JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356(16):1609–1619.

    CAS  PubMed  Google Scholar 

  34. Geoghegan J, Daniels JP, Moore PA, Thompson PJ, Khan KS, Gulmezoglu AM. Cell salvage at caesarean section: The need for an evidence-based approach. BJOG : an international journal of obstetrics and gynaecology. 2009;116(6):743–747.

    CAS  Google Scholar 

  35. Fong J, Gurewitsch ED, Kang HJ, Kump L, Mack PF. An analysis of transfusion practice and the role of intraoperative red blood cell salvage during cesarean delivery. Anesth Analg. 2007;104(3):666–672.

    PubMed  Google Scholar 

  36. Allam J, Cox M, Yentis SM. Cell salvage in obstetrics. International journal of obstetric anesthesia. 2008;17(1):37–45.

    CAS  PubMed  Google Scholar 

  37. Khan KS, Moore PAS, Wilson MJ, et al. Cell salvage and donor blood transfusion during cesarean section: A pragmatic, multicentre randomised controlled trial (SALVO). PLoS Med. 2017;14(12):e1002471.

    PubMed  PubMed Central  Google Scholar 

  38. Prick BW, Steegers EA, Jansen AJ, et al. Well being of obstetric patients on minimal blood transfusions (WOMB trial). BMC Pregnancy Childbirth. 2010;10:83.

    PubMed  PubMed Central  Google Scholar 

  39. Healy CF, Doyle M, Egan B, Hendrick B, O’Malley MK, O’Donohoe MK. Transfusion requirements and outcomes in patients undergoing abdominal aortic surgery using intra-operative cell salvage. Irish journal of medical science. 2007;176(1):33–36.

    CAS  PubMed  Google Scholar 

  40. Serracino-Inglott F, Awad S, Barclay A, Nasim A. The use of a cell saver during repair of ruptured abdominal aortic aneurysms increases early survival. Annals of the Royal College of Surgeons of England. 2005;87(6):475.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Takagi H, Sekino S, Kato T, Matsuno Y, Umemoto T. Intraoperative autotransfusion in abdominal aortic aneurysm surgery: Meta-analysis of randomized controlled trials. Archives of surgery. 2007;142(11):1098–1101.

    PubMed  Google Scholar 

  42. Markovic M, Davidovic L, Savic N, Sindjelic R, Ille T, Dragas M. Intraoperative cell salvage versus allogeneic transfusion during abdominal aortic surgery: Clinical and financial outcomes. Vascular. 2009;17(2):83–92.

    PubMed  Google Scholar 

  43. Bridgens JP, Evans CR, Dobson PM, Hamer AJ. Intraoperative red blood-cell salvage in revision hip surgery. A case-matched study. J Bone Joint Surg Am. 2007;89(2):270–275.

    CAS  PubMed  Google Scholar 

  44. Shenolikar A, Wareham K, Newington D, Thomas D, Hughes J, Downes M. Cell salvage auto transfusion in total knee replacement surgery. Transfusion medicine. 1997;7(4):277–280.

    CAS  PubMed  Google Scholar 

  45. Huet C, Salmi LR, Fergusson D, Koopman-van Gemert AW, Rubens F, Laupacis A. A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery. International Study of Perioperative Transfusion (ISPOT) Investigators. Anesth Analg. 1999;89(4):861–869.

    CAS  PubMed  Google Scholar 

  46. Wang G, Bainbridge D, Martin J, Cheng D. The efficacy of an intraoperative cell saver during cardiac surgery: A meta-analysis of randomized trials. Anesth Analg. 2009;109(2):320–330.

    CAS  PubMed  Google Scholar 

  47. Niranjan G, Asimakopoulos G, Karagounis A, Cockerill G, Thompson M, Chandrasekaran V. Effects of cell saver autologous blood transfusion on blood loss and homologous blood transfusion requirements in patients undergoing cardiac surgery on- versus off-cardiopulmonary bypass: A randomised trial. Eur J Cardiothorac Surg. 2006;30(2):271–277.

    PubMed  Google Scholar 

  48. Golab HD, Scohy TV, de Jong PL, Takkenberg JJ, Bogers AJ. Intraoperative cell salvage in infants undergoing elective cardiac surgery: A prospective trial. Eur J Cardiothorac Surg. 2008;34(2):354–359.

    PubMed  Google Scholar 

  49. Frank SM, Rothschild JA, Masear CG, et al. Optimizing preoperative blood ordering with data acquired from an anesthesia information management system. Anesthesiology. 2013;118(6):1286–1297.

    PubMed  Google Scholar 

  50. Frank SM, Thakkar RN, Podlasek SJ, et al. Implementing a health system-wide patient blood management program with a clinical community approach. Anesthesiology. 2017;127(5):754–764.

    PubMed  Google Scholar 

  51. Waters JH, Dyga RM, Waters JF, Yazer MH. The volume of returned red blood cells in a large blood salvage program: where does it all go? Transfusion. 2011;51(10):2126–2132.

    PubMed  Google Scholar 

  52. Frank SM. Who benefits from red blood cell salvage?--Utility and value of intraoperative autologous transfusion. Transfusion. 2011;51(10):2058–2060.

    PubMed  Google Scholar 

  53. Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR. Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion. 2010;50(4):753–765.

    PubMed  Google Scholar 

  54. Joseph SA, Jr., Berekashvili K, Mariller MM, et al. Blood conservation techniques in spinal deformity surgery: A retrospective review of patients refusing blood transfusion. Spine. 2008;33(21):2310–2315.

    PubMed  Google Scholar 

  55. Resar LM, Wick EC, Almasri TN, Dackiw EA, Ness PM, Frank SM. Bloodless medicine: Current strategies and emerging treatment paradigms. Transfusion. 2016;56(10):2637–2647.

    PubMed  Google Scholar 

  56. Resar LM, Frank SM. Bloodless medicine: What to do when you can’t transfuse. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program. 2014;2014(1):553–558.

    Google Scholar 

  57. Poruk KE, Valero V, 3rd, Saunders T, et al. Circulating tumor cell phenotype predicts recurrence and survival in pancreatic adenocarcinoma. Ann Surg. 2016;264(6):1073–1081.

    PubMed  PubMed Central  Google Scholar 

  58. Waters JH, Donnenberg AD. Blood salvage and cancer surgery: Should we do it? Transfusion. 2009;49(10):2016–2018.

    PubMed  PubMed Central  Google Scholar 

  59. Catling S, Williams S, Freites O, Rees M, Davies C, Hopkins L. Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood. Anaesthesia. 2008;63(12):1332–1338.

    CAS  PubMed  Google Scholar 

  60. Beck-Schimmer B, Romero B, Booy C, et al. Release of inflammatory mediators in irradiated cell salvage blood and their biological consequences in human beings following transfusion. European journal of anaesthesiology. 2004;21(1):46–52.

    CAS  PubMed  Google Scholar 

  61. Connor JP, Morris PC, Alagoz T, Anderson B, Bottles K, Buller RE. Intraoperative autologous blood collection and autotransfusion in the surgical management of early cancers of the uterine cervix. Obstetrics and gynecology. 1995;86(3):373–378.

    CAS  PubMed  Google Scholar 

  62. Nieder AM, Manoharan M, Yang Y, Soloway MS. Intraoperative cell salvage during radical cystectomy does not affect long-term survival. Urology. 2007;69(5):881–884.

    PubMed  Google Scholar 

  63. Stoffel JT, Topjian L, Libertino JA. Analysis of peripheral blood for prostate cells after autologous transfusion given during radical prostatectomy. BJU Int. 2005;96(3):313–315.

    PubMed  Google Scholar 

  64. Kumar N, Ahmed Q, Lee VK, et al. Can there be a place for intraoperative salvaged blood in spine tumor surgery? Annals of surgical oncology. 2014;21(7):2436–2443.

    PubMed  Google Scholar 

  65. Kang R, Seath BE, Huang V, Barth RJ, Jr. Impact of Autologous Blood Transfusion on Survival and Recurrence among Patients Undergoing Partial Hepatectomy for Colorectal Cancer Liver Metastases. J Am Coll Surg. 2019;228(6):902–908.

    PubMed  Google Scholar 

  66. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. The Cochrane database of systematic reviews. 2006(1):CD005033.

    Google Scholar 

  67. Waters JH, Yazer M, Chen YF, Kloke J. Blood salvage and cancer surgery: A meta-analysis of available studies. Transfusion. 2012;52(10):2167–2173.

    PubMed  Google Scholar 

  68. Waters JH, Tuohy MJ, Hobson DF, Procop G. Bacterial reduction by cell salvage washing and leukocyte depletion filtration. Anesthesiology. 2003;99(3):652–655.

    PubMed  Google Scholar 

  69. Dzik W. Use of leukodepletion filters for the removal of bacteria. Immunol Invest. 1995;24(1–2):95–115.

    CAS  PubMed  Google Scholar 

  70. Ozmen V, McSwain NE, Jr., Nichols RL, Smith J, Flint LM. Autotransfusion of potentially culture-positive blood (CPB) in abdominal trauma: preliminary data from a prospective study. J Trauma. 1992;32(1):36–39.

    CAS  PubMed  Google Scholar 

  71. Bowley DM, Barker P, Boffard KD. Intraoperative blood salvage in penetrating abdominal trauma: a randomised, controlled trial. World J Surg. 2006;30(6):1074–1080.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Johns Hopkins Health System Blood Management Program, Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Steven M. Frank

  2. Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Robert A. Sikorski

  3. Department of Anesthesiology & Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Gerhardt Konig & Jonathan H. Waters

  4. Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Diamantis I. Tsilimigras & Timothy M. Pawlik

  5. Haemonetics Corporation, Braintree, MA, USA

    Jan Hartmann & Mark A. Popovsky

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Correspondence to Timothy M. Pawlik.

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Conflict of Interest

S.M.F. is on advisory boards for Medtronic and Haemonetics.

J.H.W. is on advisory boards for LivaNova and Haemonetics.

M.A.P. and J.H. are employed by Haemonetics.

All other authors declare no competing interests.

Support for this study was provided solely from institutional and/or departmental sources.

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Frank, S.M., Sikorski, R.A., Konig, G. et al. Clinical Utility of Autologous Salvaged Blood: a Review. J Gastrointest Surg 24, 464–472 (2020). https://doi.org/10.1007/s11605-019-04374-y

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