22 December 2017

Cell salvage during caesarean section may not lead to meaningful reduction in the use of donor blood transfusions, researchers have found.

The team, led by Professor Khalid Khan of Queen Mary University of London, UK, say that, as the rate of caesareans is rising worldwide, there is a need to promote alternatives to blood transfusion.

They add, in PLoS Medicine, that cell salvage has been found to reduce the need for donor transfusion, but it hasn't been investigated in caesarean sections.

The researchers  carried out a study involving 3,028 women at risk of haemorrhage during caesarean section, and randomly assigned them to cell salvage or usual care. There was a slight reduction in the need for donor blood in the cell salvage group (2.5% needing donor blood, versus 3.5%), but this was not statistically significant.

For women who needed an emergency caesarean, the transfusion rate was lower in the cell salvage group, however this finding would need replicating to be reliable.

Among women with RhD-negative blood type who had RhD-positive babies, cell salvage was linked to an increased maternal exposure to foetal blood, which carries a risk for the mother.

"There were around 75,250 caesareans carried out in 2013-14 in the NHS," the authors write. "Of these, around 42,500 were emergency caesareans, and these potentially stand to gain from cell salvage.

“The benefit will depend on the extent to which the potential benefit would represent good value for money."

They conclude that overall, "these findings indicate that routine cell salvage does not lead to a statistically significant reduction in donor blood transfusion rates in all women at risk of haemorrhage during caesarean section.”

Source: Khan, K. S. et al. Cell salvage and donor blood transfusion during cesarean section: A pragmatic, multicentre randomised controlled trial (SALVO). PLoS Medicine 19 December 2017; doi: 10.1371/journal.pmed.1002471

Link: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002471


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