Intraoperative cell salvage for obstetrics: a prospective randomized controlled clinical trial

Ye Liu,Xiaoguang Li,Guosheng Zhao,Xiangming Che,Mingjun Xu

doi:10.1186/s12884-020-03138-w

Abstract

BackgroundThe latest basic studies and clinical evidence have confirmed the safety and efficacy of intraoperative autologous blood cell transfusion in cardiac surgery and orthopaedics. However, in caesarean section, there are still concerns about the contamination of amniotic fluid and foetal components, and consequently the application of intraoperative autologous blood cell transfusion is not universal. Therefore, this study aimed to evaluate the clinical value of intraoperative autologous blood cell transfusion in obstetric surgery.MethodsA prospective, randomized, controlled, feasibility study was performed in women undergoing caesarean section. One hundred sixteen participants were randomly assigned at a 1:1 ratio into either the intraoperative cell salvage group or the control group. Allogeneic blood cells were transfused into patients with haemoglobin concentrations < 80 g/dL in both the intraoperative cell salvage group and the control group. ResultsNo significant differences were found between the two groups in age, weight, maternal parity, history of previous caesarean section, gestational weeks of delivery, etc. However, compared with the control group, patients in the intraoperative cell salvage group had a significantly lower amount of allogeneic blood cell transfusion, lower incidence of postoperative incision infection, delayed wound healing, perioperative allergy, adverse cardiovascular events, hypoproteinaemia and shorter hospital stay. ConclusionThe results of this study suggest that the use of autologous blood cell transfusion is safe and effective for patients with obstetric haemorrhage. Trial registration: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee of Beijing Obstetrics and Gynecology Hospital, Capital Medical University (2016-XJS-003-01) as well as the 1964 Helsinki Declaration and its later amendments or other comparable ethical standards. The clinical trials were registered (ChiCTR-ICC-15,007,096) on September 28, 2015.

Highlights

The latest basic studies and clinical evidence have confirmed the safety and efficacy of intraoperative autologous blood cell transfusion in cardiac surgery and orthopaedics
This technique can significantly reduce allogeneic blood transfusion, which has been widely used in cardiac surgery and orthopaedics
Our study showed that the incidences of incision infection, delayed wound healing, perioperative allergies, adverse cardiovascular events and hypoproteinaemia were significantly lower, while the length of hospitalization was significantly shorter in the Intraoperative cell salvage (ICS) group than in the control group, confirming that a large amount of allogeneic blood cell transfusion would interfere with the immune function of patients and lead to postoperative complications

Summary

Introduction

The latest basic studies and clinical evidence have confirmed the safety and efficacy of intraoperative autologous blood cell transfusion in cardiac surgery and orthopaedics. In caesarean section, there are still concerns about the contamination of amniotic fluid and foetal components, and the application of intraoperative autologous blood cell transfusion is not universal. Intraoperative cell salvage (ICS) or autologous blood cell transfusion is the practice of recovering red blood cells from blood lost in the operative field and returning them to the patient. It is the most effective form of transfusion that avoids and reduces blood-borne diseases related to transfusion [1]. Given the concerns regarding the contamination of amniotic fluid and foetal components, the application of autologous blood cell transfusion is not universal in caesarean sections [2]. Intraoperative cell salvage infusion has been gradually applied overseas in patients with a broader range of obstetric diseases, including placenta previa, multiple caesarean sections, previous history of obstetric haemorrhage, rejection of allogeneic transfusion and severe preoperative anaemia [3, 4]

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