Intraoperative blood cell salvage in obstetrics

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on intraoperative blood cell salvage in obstetrics.

NICE considered the evidence relating to the efficacy and safety of intraoperative blood cell salvage in obstetrics (IPG144) and for intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy (IPG258) in response to concerns expressed about theoretical risks associated with the procedure.  These concerns were the possibility of amniotic fluid embolism and haemolytic disease in future pregnancies when used in obstetrics, and reinfusion of malignant cells when used in radical prostatectomy/cystectomy.

The evidence relating to safety of cell salvage in these procedures was considered adequate and therefore NICE does not intend to review its use in other specific clinical situations unless notified of new indications for intraoperative cell salvage in which there may be new safety concerns.

Intraoperative cell salvage is a commonly used technique in cardiac and orthopaedic surgery. However cell salvage has not been routinely adopted in the obstetric field for use in women at risk of postpartum haemorrhage following Caesarean section, where there may be specific safety concerns regarding embolism, or haemolytic disease as a result of re-infusion of foetal cells, or amniotic fluid.

During intra-operative blood cell salvage during Caesarean section, blood that is lost during the operation is aspirated from the surgical field using a catheter. The blood is then suctioned in a reservoir in which a filter removes gross debris. The filtered blood is then washed and re-suspended in saline for transfusion, which may be re-transfused either during or after the operation.

A leukocyte depletion filter may also be used in this process to reduce the number of leukocytes in transfused blood which may reduce adverse reactions to re-infused blood and limit disease transmission.

Other (see guidance)

Gynaecology, pregnancy and birth

Obstetrics and gynaecology

Interventional Procedures Programme
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