Abstract
Oncological surgery, obstetric haemorrhage and severe trauma are the most challenging conditions for establishing clinical recommendations for the use of cell salvage. When the likelihood of allogeneic transfusion is high, the intraoperative use of this blood-saving technique would be justified, but specific patient selection criteria are needed. The main concerns in the case of oncological surgery are the reinfusion of tumour cells, thereby increasing the risk of metastasis. This threat could be minimized, which may help to rationalize its indication. In severe peripartum haemorrhage, cell salvage has not proven cost-effective, damage control techniques have been developed, and, given the risk of fetomaternal alloimmunization and amniotic fluid embolism, it is increasingly out of use. In trauma, bleeding may originate from multiple sites, coagulopathy may develop, and it should be evaluated whether re-transfusion of autologous blood collected from uncontaminated organ cavities would be feasible. General safety measures include washing recovered blood and its passage through leukocyte depletion filters. To date, no well-defined indications for cell salvage have been established for these pathologies, but with accurate case selection and selective implementation, it could become safe and effective. Randomized clinical trials are urgently needed.
Highlights
The results of this study showed that the group with leukocyte depletion filters (LDF) had received lower allogenic blood transfusions (OR = 0.407, p = 0.03), the costs were neutral (p = 0.88) and the average length of stay in hospital was shorter by 3.76 days (p = 0.03)
The question of whether autologous blood transfusion (ABT) during liver transplantation in cases of hepatocellular carcinoma or partial liver resection for metastases from colorectal cancer increases the risk of local recurrence and whether this may have an impact on survival has been addressed by several studies but with inconclusive results
intraoperative cell salvage (ICS) should be considered in the context of any massive obstetric haemorrhage protocol, provided consensus is reached within the multidisciplinary team, all risks and benefits are individually assessed, and cost-effect is balanced [5,6,7]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The use of intraoperative cell salvage (ICS) shows great variability in clinical practice, as some pathologies may require specific patient-centred decision making, and it remains difficult to standardise an indication. A narrative review on the use of ICS in oncological surgery, peripartum haemorrhage (PPH) and trauma is presented based upon a selective review of the literature accessible through. The recovery of autologous blood in oncological surgery, PPH and major traumatic bleeding has as main drawbacks the potential risk of re-transfusion of cellular or humoral elements that are considered harmful. The presence of contaminants in recovered blood should be considered as a contraindication (Table 1), but this is controversial with little evidence to support widespread use in such conditions. The use of ICS ought to be well-protocolized to optimize its benefits while minimizing risks and potential complications, and it should be cost-effective [5,6,7]
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