Some patients who undergo surgery require blood transfusions to compensate for the blood loss that occurs during the procedure. Often the blood used for the transfusion has been donated by a volunteer. The risks associated with receiving volunteer donor blood that has been screened by a competently managed modern laboratory are considered minimal, with the risk of contracting diseases such as HIV and hepatitis C being extremely low. However there is concern in many developing countries, where there is a high prevalence of such infections and transfusion services are inadequately equipped to screen donor blood as thoroughly. Although in developed countries the risks of acquiring a disease from transfused blood are low, the financial costs associated with providing a safe and reliable blood product are escalating. Therefore there is much attention being placed on alternative strategies to minimise the need for transfusions of donor blood.
'Cell salvage' or 'autotransfusion' is one technique designed to reduce the use of such transfusions. It involves the collection of a patient's own blood from surgical sites which can be transfused back into the same person during or after surgery, as required.
The authors undertook this systematic review to examine the evidence for the effectiveness of cell salvage in reducing the need for blood transfusions of donor blood in adults (over 18 years) undergoing surgery.
The authors found 75 studies investigating the effectiveness of cell salvage in orthopaedic (36 studies), cardiac (33 studies), and vascular (6 studies) surgery. Overall, the findings show that cell salvage reduces the need for transfusions of donated blood. The authors conclude that there appears to be sufficient evidence to support the use of cell salvage in cardiac and orthopaedic surgery. Cell salvage does not appear to cause any adverse clinical outcomes.
As the methodological quality of the trials was poor, the findings may be biased in favour of cell salvage. Large trials of high methodological quality that assess the relative effectiveness, safety, and cost-effectiveness of cell salvage in different surgical procedures should be the focus of future research in this area.