Priority 23 from the Blood Transfusion and Blood Donation PSP

UNCERTAINTY: How cost effective is cell salvage for the avoidance of transfusion of donor blood during major surgery? (JLA PSP Priority 23)
Overall ranking 23
JLA question ID 0063/23
Explanatory note Not available for this PSP


NICE Guideline Recommendations:
Alternatives to blood transfusion for patients having surgery: Cell salvage and tranexamic acid
8. Do not routinely use cell salvage without tranexamic acid.
9. Consider intra-operative cell salvage with tranexamic acid for patients who are expected to lose a very high volume of blood (for example in cardiac and complex vascular surgery, major obstetric procedures, and pelvic reconstruction and scoliosis surgery).

Other refs:
1. Liu JM, Fu BQ, Chen WZ, Chen JW, Huang SH, Liu ZL. Cell salvage used in scoliosis surgery: is it really effective? World Neurosurgery. 2017. May;101:568-576
2. Xie JW, Xu B, Kang PD, Zhou ZK, Shen B, Yang J, et al. [The efficacy and safety of postoperative retransfusion drain following total hip arthroplasty: a meta-analysis]. Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]. 2016;54(-2):108-13.
3. Xie H, Pan JK, Hong KH, Guo D, Fang J, Yang WY, et al. Postoperative autotransfusion drain after total hip arthroplasty: a meta-analysis of randomized controlled trials. Scientific Reports. 2016 Jul 1;6:27461. doi: 10.1038/srep27461
4. Stone N, Sardana V, Missiuna P. Indications and outcomes of cell saver in adolescent scoliosis correction surgery: a systematic review. Spine. 2017 Mar 15;42(6):E363-E370. doi: 10.1097/BRS.0000000000001780.
5. Pawaskar A, Salunke AA, Kekatpure A, Chen Y, Nambi GI, Tan J, et al. Do autologous blood transfusion systems reduce allogeneic blood transfusion in total knee arthroplasty? Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the Esska. 2016.
6. Pan JK, Hong KH, Xie H, Luo MH, Guo D, Liu J. The efficacy and safety of autologous blood transfusion drainage in patients undergoing total knee arthroplasty: a meta-analysis of 16 randomized controlled trials. Bmc Musculoskeletal Disorders. 2016;17(-1):452-.
7. Meybohm P, Choorapoikayil S, Wessels A, Herrmann E, Zacharowski K, Spahn DR. Washed cell salvage in surgical patients: a review and meta-analysis of prospective randomized trials under PRISMA. Medicine. 2016;95(-31):e4490-e.
8. Hong KH, Pan JK, Yang WY, Luo MH, Xu SC, Liu J. Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty: a meta-analysis. Bmc Musculoskeletal Disorders. 2016;17(-1):142-.
9. Barile L, Fominskiy E, Di Tomasso N, Alpizar Castro LE, Landoni G, De Luca M, et al. Acute normovolemic hemodilution reduces allogeneic red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis of randomized trials. Anesthesia and Analgesia. 2017 Mar;124(3):743-752.
10. Zhou X, Zhang C, Wang Y, Yu L, Yan M. Preoperative acute normovolemic hemodilution for minimizing allogeneic blood transfusion: a meta-analysis. Anesthesia & Analgesia. 2015;121(-6):1443-55.
11. Xie J, Feng X, Ma J, Kang P, Shen B, Yang J, et al. Is postoperative cell salvage necessary in total hip or knee replacement? A meta-analysis of randomized controlled trials. International Journal Of Surgery. 2015;21:135-44.
12. White N, Bayliss S, Moore D. Systematic review of interventions for minimizing perioperative blood transfusion for surgery for craniosynostosis. Journal of Craniofacial Surgery. 2015;26(1):26-36.
13. Li J, Sun SL, Tian JH, Yang K, Liu R, Li J. Cell salvage in emergency trauma surgery. Cochrane Database of Systematic Reviews. 2015(1):CD007379-CD.
14. Al-Khabori M, Al-Riyami A, Siddiqi S, Al-Sabti H. Cell salvage during cardiac surgery may decrease red blood cell transfusion: a systematic review and meta-analysis. Haematologica. 2015;100((S1)):138-9.

Health Research Classification System category Generic Health Relevance
Extra information provided by this PSP
Original uncertainty examples How can we use cell salvage to reduce the need for donor blood? ~ Cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: What are the wider economic costs and benefits of alternative autologous techniques? ~ Are we using Autologous blood systems efficiently?
Submitted by 2 blood recipients ~ 2 relatives or carers of blood donors ~ 6 blood donors ~ 10 health professionals ~ 2 unknown ~ 9 other (question not from survey)
Extra information provided by this PSP
PSP unique ID 0063
PSP name Blood Transfusion and Blood Donation
Total number of uncertainties identified by this PSP 51  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 28 February 2018