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 and for intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy 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.

In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

This guidance was considered for reassessment in May 2011 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


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.

Coding recommendations

X36.4 Autologous blood salvage

Where the salvaged cells are reinfused during the same procedure the following code is also assigned:

X33.7 Autologous transfusion of red blood cells

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.