Lesson 10: Intraoperative Blood Salvage

Intraoperative Blood Salvage Overview

• Used when blood loss exceeds 1,000 mL or 20% of blood volume.
• Indicated for patients with anemia or refusing allogeneic blood (e.g., Jehovah's Witnesses).

Procedure

• Blood is collected via a suction device, treated with anticoagulants, filtered, centrifuged, and washed.
• Final product is diluted with saline and auto-transfused to the patient.
• Platelets and coagulation factors are not returned, risking dilutional coagulopathy.

Advantages of Salvaged Blood

• Higher oxygen-carrying capacity compared to banked blood.
• Contains higher concentrations of 2,3-DPG and ATP, better preservation of biconcave shape.

Risks

• Rare risks include:
  • Hypervolemia
  • Bacterial contamination
  • Hypotension
  • Nonimmune hemolysis
  • Febrile nonhemolytic reactions
  • Allergic reactions
  • Disseminated intravascular coagulation
  • Air embolus
  • Chills and skin flushing.

Contraindications

• Hemoglobin < 11 g/dL
• Infection/bacteremia
• Scheduled aortic surgery
• Unstable angina
• Recent myocardial infarction or CVA (last 6 months)
• High-grade coronary artery disease, cyanotic heart disease, uncontrolled hypertension.

Controversial Uses

• C-section: theoretically risks amniotic fluid embolism, but reviews show no increased morbidity/mortality.
• Safe for transplant surgeries.