Cell Saver

bleeding blood cell saver transfusion Apr 28, 2025

๐Ÿงช๐Ÿฉธ๐Ÿ”„ Can it be salvaged? Intraoperative cell salvage ๐Ÿ’‰๐Ÿงฌ๐ŸงŠ

Cell salvage in its current form has been used in the perioperative environment since the 1960s ๐Ÿ•ฐ๏ธ, and remains a critical strategy for blood management in the operating suite ๐Ÿฅ๐Ÿ› ๏ธ. During surgery, red cells can be harvested from the patient's own blood loss ๐Ÿ’ง, processed through a special machine ๐Ÿงฒ and then returned to the patient's own circulation via transfusion during, or immediately after surgery ๐Ÿ”๐Ÿ’‰. So how does it work? ๐Ÿค”

Blood loss from surgery can be collected by suction ๐Ÿ’จ, or from washing bloody surgical swabs ๐Ÿฉน๐Ÿงป. Suctioning can cause damage to the red cell membranes ๐Ÿงซ, so many cell salvage machines have unique suction systems that alter the suction pressure to reduce damage ๐Ÿ›ก๏ธ.

Once the blood is collected ๐Ÿฉธ, it is combined with anticoagulant ๐Ÿงช, filtered ๐Ÿงผ, and then is subject to high speed centrifugation ๐ŸŒ€, separating the different components ๐Ÿงฌ. The separated red cells are collected and then washed in normal saline ๐Ÿ’ง and prepared for re-infusion to the patient ๐Ÿ”„๐Ÿ’‰.
The other components, such as plasma proteins, anticoagulants, platelets and so on ๐Ÿงช๐Ÿฉน, are considered waste products and are discarded ๐Ÿšฎ.

The process of cell salvage is divided into three stages - collection, processing and reinfusion ๐Ÿ“Š.

Collection
Performed by the surgical team using specialised suction equipment ๐Ÿ› ๏ธ๐Ÿ’จ, with the aim of reclaiming as much blood loss as possible ๐Ÿ’ง and avoiding contaminants or other cellular material such as bone fragments or tissue ๐Ÿฆด๐Ÿงซ.

Processing
Performed by appropriately trained staff ๐Ÿ‘จ‍โš•๏ธ๐Ÿ‘ฉ‍โš•๏ธ, and in many cases this is by a cell saver rep ๐Ÿง‘‍๐Ÿ”ฌ. Processing involves isolating the red cells ๐Ÿงฌ and washing them ๐Ÿ’ง, preparing them for reinfusion ๐Ÿ”.

Reinfusion
Should take place within 6 hours of the first collection โณ, in order to protect the integrity of the red cells and optimise circulating volume ๐Ÿ’“.

Advantages of cell salvage are the sparing of donor blood products ๐Ÿฉธ๐Ÿ™…‍โ™‚๏ธ, and a much safer transfusion process ๐Ÿ›ก๏ธ in that there are no restrictive features of transfusion associated with blood management principles as the patient is receiving their own blood products ๐Ÿงฌ. Oxygen delivery from salvage blood products is also superior to donor blood ๐Ÿ’จ๐Ÿ’‰, and there are no adverse immunological effects ๐Ÿšซ๐Ÿ›‘.

Disadvantages are that cell salvage is not appropriate for all operative blood loss scenarios โš ๏ธ, and patients need to be selected on an individual basis ๐Ÿ‘ค๐Ÿ“‹. Cell salvage requires specialised equipment ๐Ÿ› ๏ธ and highly trained operators ๐Ÿ‘ฉ‍๐Ÿ”ง๐Ÿ‘จ‍๐Ÿ”ง, so is much more labour intensive than donor blood administration ๐Ÿ’ช. It also takes several minutes for blood to be processed โŒ›, which may pose challenges in time critical massive haemorrhage scenarios ๐Ÿšจ๐Ÿ’‰.

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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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