Salvaging blood during cesarean section may have potential in emergency procedures

December 19, 2017

Using cell salvage, the reinfusion of red blood cells lost during surgery, did not lead on average to a statistically significant reduction in the rates of blood transfusion needed by all women undergoing caesarean section, according to a study published this week in PLOS Medicine by Khalid Khan from Queen Mary University of London, UK, and colleagues.

Excessive hemorrhage during caesarean sections, one risk of the procedure, requires treatment by transfusion of donated blood components. In the new study, aiming to determine whether cell salvage could minimize the use of donor blood, researchers randomly assigned 3,028 women at risk of hemorrhage during caesarean section from 26 obstetric units to routine use of cell salvage (intervention group) or current standard of care without routine salvage use (control group).

Donor blood transfusion rates were 2.5% in the intervention group and 3.5% in the control group; the difference was not statistically significant (adjusted odds ratio 0.65; 95% confidence interval 0.42 to 1.01, p=0.056). In a planned subgroup analysis, the transfusion rate was lower in the intervention compared with control group for women undergoing emergency caesareans (3.0% vs 4.6%, adjusted odds ratio 0.58, 95% confidence interval 0.34 to 0.99), although additional research may be needed to confirm whether cell salvage could be effective in these women.

"There were around 75,250 caesareans carried out in 2013-14 in the NHS. Of these, around 42,500 were emergency caesareans, and these potentially stand to gain from cell salvage" the authors say. "The benefit will depend on the extent to which the potential benefit would represent good value for money."
-end-
Research Article

Funding:

This project was funded by the UK National Institute for Health Research Health Technology Assessment programme (project number 10/57/32, https://www.journalslibrary.nihr.ac.uk/programmes/hta/105732#/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: Primary NIHR grant supporting the roles of KK, PM, RH, IW, LB, TR, CM, JDa, SR, DL and JDo. PM also declares having been a co-applicant for two other NIHR-funded grants over within the last five years. Other than this, all authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Citation:

Khan KS, Moore PAS, Wilson MJ, Hooper R, Allard S, Wrench I, et al. (2017) Cell salvage and donor blood transfusion during cesarean section: A pragmatic, multicentre randomised controlled trial (SALVO). PLoS Med 14(12): e1002471. https://doi.org/10.1371/journal.pmed.1002471

Author Affiliations:

Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom

Birmingham Women's Hospital, Birmingham, United Kingdom

School of Health and Related Research, University of Sheffield, United Kingdom

Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, United Kingdom

NHS Blood and Transplant, London, United Kingdom

Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom

Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom

Nottingham Clinical Trials Unit, University of Nottingham, United Kingdom

Singleton Hospital, Swansea, United Kingdom

Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom

Institute of Cellular Medicine, Newcastle University, United Kingdom

Peri-operative, Critical Care and Trauma Trials Group, University of Birmingham, United Kingdom

Royal London Hospital, Barts Health NHS Trust, London, United Kingdom

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

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