Patient Blood Management from the Perspective of Cell Salvage

Rezaei, AR; Rezaei, A; Kargarzadeh, A.H

Patient Blood Management from the Perspective of Cell Salvage

Authors

AR Rezaei ¹

A Rezaei ²

A.H Kargarzadeh ³

¹ M.Sc. Medical Engineering, Department of Biomaterials, Science and Research Branch, Islamic Azad University, Tehran, Iran

² Master of Science in Biomedical Engineering, Islamic Azad University, Tehran Science and Research Branch

³ Bachelor of Science in Microbiology, Islamic Azad University, Arak Branch

Abstract

Background and Objective: The reliance on allogeneic blood during high-risk surgical procedures, particularly in cardiac surgery, presents significant challenges for healthcare systems. Complications associated with blood transfusions—including increased susceptibility to infections, immune reactions, coagulopathies, and prolonged hospital stays—emphasize the urgent need for effective patient blood management (PBM) programs. Cell salvage (CS) has emerged as a crucial component within the PBM framework, enabling the collection, washing, and reinfusion of autologous blood. This study aims to provide a comprehensive review of the clinical evidence regarding the safety, efficacy, and advantages of using CS in cardiac surgery.
Materials & Methods: This study employs a narrative review approach, utilizing searches across multiple databases, including Google Scholar, PubMed, ScienceDirect, and Cochrane. A comprehensive examination of the published literature related to CS—comprising clinical evaluations, laboratory studies, and systematic reviews—was performed. No temporal restrictions were applied, and inclusion criteria focused on studies relevant to cardiac surgery and the application of CS in minimizing allogeneic blood consumption.
Results: The reviewed studies consistently demonstrate that the implementation of CS significantly reduces the need for allogeneic blood transfusions, thereby mitigating complications associated with transfusions. Notably, the use of CS enables the recovery of packed red blood cells (PRBCs) with reduced levels of inflammatory mediators, including various cytokines, potentially alleviating postoperative inflammatory responses. Importantly, CS has not been associated with an increased risk of infection transmission or the development of infections. Furthermore, assessments of the coagulation profile of blood processed through CS indicate that the resulting PRBCs maintain normal coagulation factors and do not contribute to thrombotic events. However, it is crucial to adhere to established guidelines recommending coagulation profile assessments and the administration of fresh frozen plasma (FFP) in cases of blood loss exceeding 1000 milliliters, typically at an FFP-to-blood ratio of 1:1.
Conclusion: The findings confirm that CS is a highly effective blood management strategy that significantly reduces allogeneic blood consumption and its associated complications. The observed reduction in inflammatory markers, absence of increased infection risk, and preservation of coagulation profiles further underscore the safety and efficacy of this approach. Therefore, incorporating CS into surgical protocols—particularly for procedures involving moderate to severe bleeding—may improve clinical outcomes and decrease reliance on allogeneic blood products. Additionally, economic analyses from countries with established PBM programs demonstrate substantial reductions in hospital and transfusion-related costs.

Keywords

Blood Transfusion

Autologous

Inflammation Mediators

Hematopoietic Stem Cell Transplantation

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