This document summarizes cell salvage, a process where blood lost during surgery is collected, filtered, and reinfused back to the patient. It discusses the indications, contraindications, and procedure for cell salvage. Some key points include: - Cell salvage involves collecting blood from the surgical site, removing clots and debris, separating red blood cells from other components, and reinfusing the red cells. - It is indicated for surgeries with anticipated blood loss over 1 liter or 20% of blood volume to avoid allogeneic transfusions. - Contraindications include the presence of contaminants like urine or cancer cells that could be reinfused. - The procedure

1. CELL SALVAGE
DR.ABHINAV CHAUDHARY
JR,DEPARTMENT OF ANAESTHESIOLOGY
IGGMC,NAGPUR

2. CONTENTS
INTRODUCTION
CELL SALVAGE;PATIENT CRITERION
INDICATIONS AND CONTRAINDICATIONS
SPECIFIC CONDITIONS
PROCEDURE AND STEPS
PREOPERATIVE BLOOD DONATION
ACUTE NORMOVOLUEMIC HAEMODILUTION

3. ONE OF THE METHODS OF AUTOLOGOUS BLOOD TRANSFUSION
ACUTE NORMOVOLEMIC HAEMODILUTION
PREOPERATIVE AUTOLOGOUS DONATION
CELL SALVAGE :INTRAOPERATIVE AND POST OPERATIVE
FIRST MENTION DOCUMENTED IN LATE 1800 ,ENGLISH SURGEON JAMES HIGHMORE
PROPOSED THE USE OF “AUTO TRANSFUSION”
INTRODUCTION

4. LANCET 1874 ADVOCATED INTHE TRAOPERATIVE AUTOTRANSFUSION
POST WORLD WAR ERA REVIVED THE INTEREST IN AUTOTRANSFUSION
AMERICAN SURGEON KLEBANOFF STARTED USING OPEN HEART DEVICE
CAPTURE;ANTICOAGULATE;FILTER AND REINFUSE
COMERCIALLY AVAILABLE BY BENTLEY LABORATORIES IN THE 1970

5. CELL SALVAGE
PROCESS IN WHICH THE BLOOD FROM SURGICAL FIELD IS COLLECTED, FILTERED AND
WASHED.
EARLIER SIMPLE FITERING - NOWADAYS HEPARINIZED NORMAL SALINE OR CITRATE
ANTICOAGULANT ADDED.
RED CELLS ARE RETAINED
PLASMA,PLATELETS,HEPARIN,FREE HAEMOGLOBIN AND INFLAMMATORY MEDIATORS ARE
DISCARDED.
RESULTING RED CELLS ARE FINALLY RESUSPENDED IN NORMAL SALINE,AT A
HAEMATOCRIT OF 50 TO 70 % AND REINFUSED.

6. PATIENT CRITERIA
ANTICIPATED BLOOD LOSS OF >1 LITRES OR >20% OF THE BLOOD VOLUME.
PREOPERATIVE ANAEMIA OR INCREASED RISK FACTORS FOR BLEEDING.
RARE BLOOD GROUPS OR ANTIBODIES.
REFUSAL TO ACCEPT ALLOGENIC BLOOD.
SURGERIES IN WHICH BLOOD WOULD ORDINARILY BE CROSSMATCHED OR WHERE MORE THAN
10% OF THE PATIENTS UDERGOING THE PROCEDURE REQUIRE TRANSFUSION.

7. INDICATIONS
CARDIAC SURGERY VALVE REPLACEMENT
REDO BYPASS SURGERY
ORTHOPAEDIC MAJOR SPINE SURGERY
BILATERAL KNEE REPLACEMENT,HIP REPLACEMENT
UROLOGY RADICAL RETROPUBIC PROSTATECTOMY
CYSTECTOMY,NEPHRECTOMY
NEUROSURGERY GIANT BASILAR ANEURYSM
VASCULAR SURGERY THORACOABDOMINAL AORTIC ANEURYSM REPAIR

8. CONTRAINDICTIONS
PHARCOLOGICAL AGENTS
CLOTTING AGENTS (AVITENE,SURGICAL GELFOAM)
IRRIGATING AGENTS (BETADINE,AB USED FOR TOPICAL APPLICATION)
METHYL METHAACRYLATE
CONTAMINANTS
URINE,BONE CHIPS,FAT
BOWEL CONTENTS
AMNIOTIC FLUID
MALIGNANCY
HAEMATOLOGICAL DISORDERS

9. SPECIFIC CONDITIONS
JEHOVAH WITNESSES
ACCEPTABLE WITH THEIR CONSENT PROVIDED THAT THE BLOOD REMAINS IN
CONTINUITY WITH THEIR CIRCULATION.
CARDIOTHORACIC AND VASCULAR SURGERIES
MOST CARDIAC UNITS NOW USE INTRAOPERATIVE CELL SALVAGE FOR COMPLEX AND
COMBINED PROCEDURES;ALL CARDIAC SURGERIES REQUIRING CARDIOPULMONARY BYPASS.
PAEDIATRIC SURGERIES
REDUCES ALLOGENIC EXPOSURE
CONTINUOUS PROCESSING IS PREFERABLE

10. OBSTETRICS
LIFE SAVING OPPORTUNITY
PERIPARTUM PERIOD ;CONTAMINATD WITH BACTERIA,AMNIOTIC FLUID,FOETAL BLOOD
AMNIOTIC FLUID EMBOLISM
ANTIGEN ANTIBODY COMPLEXES THAT MAY FORM SECONDARY TO RH DIFFERENCES
CANCER SURGERY
POSSIBILITY OF REINFUSION OF TUMOR CELLS,POTENTIALLY GIVING RISE TO
DISTANT METASTASIS.
BOWEL SURGERY
PENETRATING TRAUMATIC INJURY TO LARGE BOWEL,SURGERY INVOLVING INFECTED
WOUND,LOWER GI SURGERIES.
EVERY EFFORT SHOULD BE MADE TO MINIMISE BACTERIAL LOAD.

11. SICKLE CELL DISEASE AND THALLASSEMIA
READMINITERED TO THE PATIENT WILL SICKLE AND FURTHER REDUCE
OXYGEN CARRYING CAPACITY.
CHANCES OF HAEMOLYSIS AND ANAEMIA.
CARBON MONO OXIDE
USE OF ELECTROCAUTERY
SHOWN THAT WHILE CO RAISED IN CELL SALVAGED BLOOD,
NOT CLINICALY SIGNIFICANT.
PHEOCHROMOCYTOMA
VASOACTIVE SUBSTANCES
DANGER OF HYPERTENSION AND MI

12. PROCEDURE
COMBINATION OF SUCTION AND SWABS
LARGE BORE SUCTION MIN 4mm
LOW VACCUM PRESSURE <150 mm Hg
ANTICOAGULANT
HEPARIN 1:5 ,60 TO 80 DROPS PER MINUTE
CITRATE 1:7,40 TO 60 DROPS PER MINUTE

13. STEPS
SUCTION
BLOOD IS SUCKED AWAY FROM OPERATIVE SITE VIA DOBLE LUMEN TUBE
MIXED WITH ANTICOAGULANT .
FILTRATION
REMOVAL OF LARGE CLOTS AND DEBRIS
40-150

14. SEPARATION
REMAINING VOLUME DRAWN INTO A CENTRIFUGE TO BE PROCESSED
STERILE ISOTONIC SALINE SOLUTION PUMPED INTO THE CENTRIFUGE BOWL
FORCED SUPPLIED BY THE CENTRIFUGE HOLDS MORE DENSE RBCs AGAINST THE OUTER WALL
LESS DENSE CENTRE AND FURTHER SPILLS OVER IN WASTE BAG
ALMOST ONE THIRD OF THE RBC VOLUME MAY BE LOST IN THIS PROCESS
PHOTOOPTICS ARE USED TO DETECT MAXIMUM CELL DENSITY AND TO INITIATE WASHING
OF THE PACKED SUSPENTION WITH A SELECT VOLUME OF SALINE.

15. DISPOSAL
WASTE PRODUCTS,INCLUDING WBCs,PLATELET ,PLASMA,ANTICOAGULANT,FAT,CLOTTING
FACTORS,FREE PLASMA HAEMOGLOBIN.
CELL SALVAGE
RBCs collected in separate bag
QUALITITY DEPENDS ON VOLUME OF WASH SOLUTION
DEGREE OF CONCENTRATION ACHIEVED
QUALITY OF BLOOD BEFORE WASHING
TYPE OF SURGERY
PRESENCE OF RESIDUAL CONTAMINANTS

16. REINFUSION
COLLECTED RED CELLS ARE REINFUSED IMMEDIATELY OR UPTO 4 HOURS AFTER
PROCESSING IF KEPT AT ROOM TEMPERATURE
CITRATE TOXICITY
PROPER LABELLING
GENERIC LABELS

17. DIFFERENT SYSTEMS AVAILABLE
FIXED VOLUME BOWL SYSTEMS
REQUIRE A FIXED MINIMUM VOLUME IN THE BOWL FOR PROCESSING TO BE STARTED.
VARIABLE VOLUME DISK SYSTEMS
REQUIRE VERY SMALL VOLUME OF BLOOD.
DELIVERS VARIABLE VOLUME OF RED CELLS WITH FIXED HAEMATOCRIT.
CONTINUOUS ROTATORY SYSTEM
WASHING AND PROCESSING TAKES PLACE CONTINUOSLY AND PRODUCES A HIGHER HAEMATOCRIT.
VOLUME INDEPENDENSE:INITIAL VOLUME REQUIRED 15 TO 30 ml
MINIMIZES WASTAGE

19. PREOPERATIVE BLOOD DONATION
PATIENT CRITERIA
DONOR PATIENT HAEMOGLOBIN >11g/dl OR HAEMATOCRIT NO LESS THAN 33% BEFORE
EACH DONATION
NO AGE OR WEIGHT LIMITS
10.5 ml /kg
MORE THAN ONCE A WEEK
LAST DONATION 72 HOURS BEFORE

20. CONTRAINDICATIONS
EVIDENCE OF INFECTION OR RISK OF BACTEREMIA
SCHEDULED SURGERY TO CORRECT AORTIC STENOSIS
UNSTABLE ANGINA
ACTIVE SEIZURE DISORDER
MI OR CEREBROVASCULAR ACCIDENT WITHIN 6 MONTHS OF DONATION
SEVERE CARDIAC OR PULMONARY DISEASE
HIGH GRADE LEFT MAIN CORONARY ARTERY DISEASE
CYANOTIC HEART DISEASE
UNCONTROLLED HYPERTENSION

21. ADVANTAGES
PREVENTS TRANSFUSION TRANSMITTED DISEASES
PREVENTS RED CELL ALLOIMMUNISATION
SUPPLEMENTS THE BLOOD SUPPLY
COMPATIBLE BLOOD FOR PATIENTS
PREVENTS ADVERSE TRANSFUSION REACTIONS
REASSURANCE TO PATIENTS CONCERNED ABOUT BLOOD TRANSFUSION RISKS

22. DISADVANTAGES
DOES NOT AFFECT THE RISK OF BACTERIAL CONTAMINATION
DOES NOT AFFECT THE RISK OF ABO COMPATIBILITY ERROR
COSTLIER THAN ALLOGENIC BLOOD
WASTAGE OF BLOOD NOT TRANSFUSED WITH ALLOANTIBODIES
SUBJECTS THE PATIENT TO PERIOPERATIVE ANAEMIA
HAS AN INCREASED INCIDENCE OF ADVERSE REACTIONS TO AUTOGOUS DONATION

23. ACUTE NORMOVOLUEMIC
HAEMODILUTION
REMOVAL OF WHOLE BLOOD FROM A PATIENT WHILE RESTORING THE CIRCULATORY BLOOD
VOLUME WITH AN ACELLULAR FLUID BEFORE AN ANTICIPATED SIGNIFICANT BLOOD LOSS.
BLOOD IS THEN STORED AT ROOM TEMPERATURE
CRYTALLOIDS AND COLLOIDS
REINFUSED IN REVERSE ORDER
LARGEST HAEMATOCRIT AND CONCENTRATION OF COAGULATION FACTORS AND PLATELETS.

24. CRITERIA
LIKELIHOOD OF TRANSFUSION EXCEEDING 10%
PREOPERATIVE HAEMOGLOBIN LEVEL OF AT LEAST 12g/dl
ABSENSE OF SIGNIFICANT PULMONARY,CARDIAC,RENAL OR LIVER DISEASE
ABSENCE OF SEVERE HYPERTENSION
ABSENCE OF INFECTION AND RISK OF BACTEREMIA

25. REDUCTION OF RED BLOOD CELL LOSSES
REDUCTION OF RBC LOSSES WHEN WHOLE BLOOD IS SHED PREOPEARATIVLY AT ALOWER
HAEMATOCRIT
IMPROVED OXYGENATION
WITHDRAWAL OF WHOLE BLOOD AND REPLACEMENT WITH CRYTALLOID OR COLLOID SOLUTIONS
DECREASES THE OXYGEN CARRYING CAPACITY
BUT COMPENSATORY HAEMODYNAMIC MECHANISM AND EXSISTENCE OF SURPLUS OXYGEN
SUPPLY MAKES ANH SAFE.
DECREASED VISCOSITY
PRESERVATION OF HAEMOSTASIS
STORED AT ROOM TEMPERATURE,REINFUSED WITHIN 8hrs
DETERIORATION OF PLATELET AND COAGULATION FACTORS IS MINIMAL

26. THANK YOU
PRESENTED BY
DR.ABHINAV CHAUDHARY.