title: Implementation of an obstetric cell salvage service in a tertiary women's hospital.
abstract: BACKGROUND
  Intraoperative cell salvage (ICS) is an important aspect of patient blood management programmes. An ICS service was introduced at KK Women's and Children's Hospital, Singapore, from 2 May 2011 to 30 April 2013 to aid in the management of massive obstetric haemorrhage.
  
  
  METHODS
  With support from the Ministry of Health's Healthcare Quality Improvement and Innovation Fund, a workgroup comprising obstetricians, anaesthetists and nursing staff was formed to develop training requirements, clinical guidelines and protocols for implementing ICS using the Haemonetics Cell Saver 5. Pregnant women with an anticipated blood loss of > 1,000 mL during Caesarean delivery, a baseline haemoglobin level of < 10 g/dL, rare blood types and who had refused donor blood were recruited to the service after obtaining informed consent.
  
  
  RESULTS
  A total of 11 women were recruited to the ICS service; the primary indications were placenta praevia and placenta accreta. Median blood loss in these 11 patients was 1,500 (range 400-3,000) mL. In four patients, adequate autologous blood was collected to initiate processing and salvaged, processed blood was successfully reinfused (mean 381.3 [range 223.0-700.0] mL). Median blood loss among these four patients was 2,000 (range 2,000-3,000) mL. No adverse event occurred following autologous transfusion. Mean immediate postoperative haemoglobin level was 8.0 (range 7.1-9.4) g/dL.
  
  
  CONCLUSIONS
  The implementation of an obstetric ICS service in our institution was successful. Future studies should seek to address the cost-effectiveness of ICS in reducing allogeneic blood utilisation.
authors: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
authors: Eileen
authors: E
authors: Lew
authors: Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore.
authors: Shephali
authors: S
authors: Tagore
mesh_terms: D001793:Blood Preservation; D001804:Blood Transfusion, Autologous / Q000379:methods* / Q000592:standards; D003362:Cost-Benefit Analysis; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D009774:Obstetrics / Q000379:methods* / Q000592:standards; D057725:Operative Blood Salvage / Q000379:methods* / Q000592:standards; D010921:Placenta Accreta / Q000628:therapy; D010923:Placenta Previa / Q000628:therapy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016730:Program Development; D015397:Program Evaluation; D012846:Singapore; D062606:Tertiary Care Centers
chemical_list: D006454:Hemoglobins
keywords: autologous transfusion; cell salvage; cell saver; obstetric haemorrhage; postpartum haemorrhage