Is the "salvaged-cell syndrome" myth or reality?
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.
Tawes
R L
RL
Department of Surgery, Mills-Peninsula Hospital, Burlingame-San Mateo, California, USA.
Duvall
T B
TB
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