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Neef V, Meybohm P, Zacharowski K, Kranke P. Current concepts in the use of cell salvage in obstetrics. Curr Opin Anaesthesiol 2024; 37:213-218. [PMID: 38391030 PMCID: PMC11062610 DOI: 10.1097/aco.0000000000001337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient's own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. RECENT FINDINGS Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage. SUMMARY Intraoperative cell salvage is a strategy to maintain the patient's own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.
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Affiliation(s)
- Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy
| | - Patrick Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy
| | - Peter Kranke
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
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Etemady M, Hajizadeh M, Gidaszewski B, Swain JA, Chua SC, Khajehei M. Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure. World J Obstet Gynecol 2023; 12:33-44. [DOI: 10.5317/wjog.v12.i4.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/04/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia. Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women. The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status, and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available. To reduce the risk, intravenous iron infusion is proposed as a bloodless therapeutic approach. There are a variety of iron preparations. Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia, especially in resource-scarce settings. It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes. According to the literature, when haemoglobin is greater than 90 g/L, blood transfusion is not often required. In perinatal women with anaemia, the decision whether to administer blood or iron is based on patient preferences, haemoglobin levels, clinical symptoms, past and present medical conditions and the clinician’s judgement. Nevertheless, due to the lack of rigid criteria for blood transfusions in the majority of clinical settings, it is considered the default treatment for anaemia in perinatal women.
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Affiliation(s)
- Mike Etemady
- School of Health Sciences, University of Sydney, Sydney, Australia, Sydney 2000, NSW, Australia
| | - Melika Hajizadeh
- Stotts College, Acknowledge Education, Sydney 2000, NSW, Australia
| | - Beata Gidaszewski
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
| | - Julie Ann Swain
- Women's and Newborn Health, Westmead hospital, Westmead 2145, NSW, Australia
| | - Seng Chai Chua
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Clinical School, Western Sydney University, Sydney 2145, NSW, Australia
| | - Marjan Khajehei
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney 2145, NSW, Australia
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