Red cell salvage in orthopedic surgery

SUMMARY The increasing number of surgical procedures has raised the demand for allogeneic blood to a level that often exceeds supply. Moreover, 10% of all transfusions are given in the orthopedic surgery setting, requiring the avoidance of liberal transfusion criteria to further reduce the risk of infection and other complications. As a result, a series of blood‐conservation measures have been developed. In this article, we review the use of autologous transfusion in orthopedic surgery, with a special focus on perioperative red cell salvage. From data reviewed, it can be concluded that perioperative salvage of blood, either intraoperative cell salvage or postoperative cell salvage, seems to be an excellent source of functional and viable red cells, without many of the transfusion‐related risks and with few side effects. The effectiveness of perioperative cell salvage to reduce exposure to allogeneic blood is greatly enhanced by the implementation of a restrictive transfusion protocol and the association with other blood‐sparing strategies [preoperative autologous blood donation (PABD), erythropoietin, intravenous iron], especially in anemic patients. Moreover, perioperative cell salvage may reduce the number of required PABD units or render PABD unnecessary. Finally, although formal cost‐effectiveness studies on perioperative cell salvage are lacking, based on current allogeneic blood transfusion costs, it is generally accepted that the equivalent of at least one unit of blood needs to be recovered for these techniques to be cost‐effective. Therefore, these procedures should be used on a case‐by‐case basis.