7 October 2019

Blood saves lives; it is a lifeline in an emergency, is vital in surgery and is essential for people on long-term treatments.

That means we need donors from all backgrounds and blood types to ensure the right blood is available for patients who desperately need it. 

However, there is a national shortage.    

Nearly 400 new blood donors are required each day to meet demand and around 135,000 needed each year to replace those who can no longer donate. 

Therefore, it is critical to make the best use out of the blood that we do have available. 

Cell salvage is a technique that does just that.

It is the process of collecting all blood that is lost from the beginning of surgery, allowing patients to receive their own blood back during surgery. 

The chance of then needing bank blood is much reduced, although may still be necessary if some blood can’t be collected or bleeding is happening too quickly. 

Cell saver machines are run by perfusionists who are the specialists on the equipment.

“The benefits of cell salvage are abundant,” explained Professor Andrew Klein, Consultant Anaesthetist at Royal Papworth Hospital NHS Foundation Trust. “It reduces infection as you aren’t putting someone else’s blood in your body and that helps to improve the body’s immune response.

“It also means that fewer units of blood are being used which allows more to be available elsewhere. That in turn reduces cost for the Trust which ultimately allows us to do more surgery, and thus save more lives.”

The machines essentially extract a patient’s blood during surgery, ‘wash’ the blood and then return it to the body.

According to a 2018 paper which took data from 47 trials from around the world including one at Royal Papworth, cell salvage;

•    Reduces the use of blood from the blood bank by 40%
•    Reduces risk of infection by 30% 
•    Reduces a patient’s stay in hospital by two days 

Professor Klein chaired the group that in September 2018 devised the new national guidelines on cell salvage, which stated that cell salvage equipment and staff trained to operate it should be immediately available 24 hours a day in all NHS hospitals.  

One year on, surgical teams at Royal Papworth are delivering on those guidelines, having invested significantly in both the equipment and training needed to provide the service.

“We use cell salvage for every patient in surgery who needs blood, which works out at about half of our cardiac and transplant surgery and some thoracic. However, there will be times when we need additional blood and that is of course taken from the bank,” Professor Klein said.

“This practice of cell salvage started about 20 years ago and we now have new and better technology, but it’s expensive and so not all Trusts have made that financial outlay. 

“At Royal Papworth, we have made that commitment to provide this service to our patients 24/7 and now have one cell salvage machine for each theatre and five for our Critical Care Unit.

“Although it required initial capital investment, we are now reaping the benefits in terms of patient safety, length of hospital stay and thus freeing up bed days, and financial savings to the Trust.”