title: Is the "salvaged-cell syndrome" myth or reality?
abstract: BACKGROUND
  Intraoperative autotransfusion (IAT) has been implicated in anecdotal cases and experimental models to precipitate, aggravate, or exacerbate a coagulopathy. This study assesses this hypothesis.
  
  
  METHODS
  A retrospective database review of over 36,000 multispecialty cases of IAT during an 18-year experience was conducted with special reference to the occurrence of coagulopathy (disseminated intravascular coagulation [DIC]) in association with adult respiratory syndrome (ARDS).
  
  
  RESULTS
  The incidence of coagulopathy was low (0.05%). A total of 18 cases of DIC/ARDS were identified: 10 associated with ruptured aneurysms, 6 following massive trauma, and 2 after complex redo cardiac surgery. All 18 patients suffered shock and profound hypothermia. The mean transfusion requirement was 28 units. The mortality was 100%.
  
  
  CONCLUSIONS
  Although some degree of bleeding and clotting disorders are not uncommon in major cases, in our experience coagulopathy occurs infrequently and is a result of a complex interaction of shock, hypothermia, and multiple transfusions. It is our contention that these factors trigger the DIC, not the autotransfusor, and that the ARDS results from reperfusion injury following a profound ischemic event, associated in many cases with multiorgan failure.
authors.affiliation: Department of Surgery, Mills-Peninsula Hospital, Burlingame-San Mateo, California, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Tawes
authors.forename: T B
authors.initials: TB
authors.lastname: Duvall
mesh_terms: D001804:Blood Transfusion, Autologous / Q000009:adverse effects* / Q000295:instrumentation*; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007432:Intraoperative Period; D008499:Medical Records; D009102:Multiple Organ Failure / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies