Abstract
Background: Intraoperative cell salvage (ICS) has been used in more than 1100 published obstetrics cases and can reduce the need for allogeneic transfusion effectively. However, ICS could lead to a life-threatening coagulopathy called salvaged blood syndrome (SBS). SBS was reported in several non-obstetric cases but has rarely been reported in obstetric patients. Cases: We reviewed all 841 cell savage cases that occurred in our hospital prior to October 2018. Here, we present 3 cases of coagulopathy in patients who received ICS after cesarean section. The rate of obstetrical SBS in our hospital was 0.46%. Dicussion: Cesarean section was performed without severe hemorrhage, and we performed the surgical hemostatic procedures as usual. Then, several hours after the surgery and after ICS, bleeding occurred, in which hypofibrinogenemia was more severe than expected based on the amount of postpartum hemorrhage. In addition, other marked changes in coagulation function-related parameters, including a decline in the platelet count and obvious prolongation of the PT and aPTT levels, were also observed. More specific and in-depth studies concerning obstetric SBS are needed.
Highlights
Hemorrhage is the leading cause of maternal morbidity and maternal death worldwide [1]
Dicussion: Cesarean section was performed without severe hemorrhage, and we performed the surgical hemostatic procedures as usual
We reviewed all 841 cell savage cases that occurred in our hospital until October 2018 and found the three cases described here, and the rate of salvaged blood syndrome (SBS) in the obstetrical unit in our hospital was 0.46%, which was similar to that observed in the abovementioned study
Summary
Hemorrhage is the leading cause of maternal morbidity and maternal death worldwide [1]. The appropriate use of intraoperative cell salvage (ICS) in obstetrics can reduce the need for allogeneic transfusion and has been used in more than 1100 published cases [2,3]. Amniotic fluid embolism (AFE) has never been reported and remains theoretical [2]. ICS could lead to a life-threatening coagulopathy called salvaged-blood syndrome (SBS). SBS has been reported in several nonobstetric cases [4,5]. There has been only one case report of an obstetric patient with reinfusion of more than 2 L of blood cells [6]. We present here 3 cases of coagulopathy in patients who received ICS after cesarean section
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