Cell Saver
Apr 28, 2025
๐งช๐ฉธ๐ Can it be salvaged? Intraoperative cell salvage ๐๐งฌ๐ง
Cell salvage in its current form has been used in the perioperative environment since the 1960s ๐ฐ๏ธ, and remains a critical strategy for blood management in the operating suite ๐ฅ๐ ๏ธ. During surgery, red cells can be harvested from the patient's own blood loss ๐ง, processed through a special machine ๐งฒ and then returned to the patient's own circulation via transfusion during, or immediately after surgery ๐๐. So how does it work? ๐ค
Blood loss from surgery can be collected by suction ๐จ, or from washing bloody surgical swabs ๐ฉน๐งป. Suctioning can cause damage to the red cell membranes ๐งซ, so many cell salvage machines have unique suction systems that alter the suction pressure to reduce damage ๐ก๏ธ.
Once the blood is collected ๐ฉธ, it is combined with anticoagulant ๐งช, filtered ๐งผ, and then is subject to high speed centrifugation ๐, separating the different components ๐งฌ. The separated red cells are collected and then washed in normal saline ๐ง and prepared for re-infusion to the patient ๐๐.
The other components, such as plasma proteins, anticoagulants, platelets and so on ๐งช๐ฉน, are considered waste products and are discarded ๐ฎ.
The process of cell salvage is divided into three stages - collection, processing and reinfusion ๐.
Collection
Performed by the surgical team using specialised suction equipment ๐ ๏ธ๐จ, with the aim of reclaiming as much blood loss as possible ๐ง and avoiding contaminants or other cellular material such as bone fragments or tissue ๐ฆด๐งซ.
Processing
Performed by appropriately trained staff ๐จโ๏ธ๐ฉโ๏ธ, and in many cases this is by a cell saver rep ๐ง๐ฌ. Processing involves isolating the red cells ๐งฌ and washing them ๐ง, preparing them for reinfusion ๐.
Reinfusion
Should take place within 6 hours of the first collection โณ, in order to protect the integrity of the red cells and optimise circulating volume ๐.
Advantages of cell salvage are the sparing of donor blood products ๐ฉธ๐ โ๏ธ, and a much safer transfusion process ๐ก๏ธ in that there are no restrictive features of transfusion associated with blood management principles as the patient is receiving their own blood products ๐งฌ. Oxygen delivery from salvage blood products is also superior to donor blood ๐จ๐, and there are no adverse immunological effects ๐ซ๐.
Disadvantages are that cell salvage is not appropriate for all operative blood loss scenarios โ ๏ธ, and patients need to be selected on an individual basis ๐ค๐. Cell salvage requires specialised equipment ๐ ๏ธ and highly trained operators ๐ฉ๐ง๐จ๐ง, so is much more labour intensive than donor blood administration ๐ช. It also takes several minutes for blood to be processed โ, which may pose challenges in time critical massive haemorrhage scenarios ๐จ๐.
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References:
Carroll, C., Young, F. (2021) Intraoperative cell salvage. BJA education. V 21(3) pp 95-101. DOI: 10.1016/j.bjae.2020.11.007
National blood authority (2024). Guidance for the provision of intraoperative cell salvage. NBA Australia. https://www.blood.gov.au/guidance-provision-intraoperative-cell-salvage
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