UOC Immunoematologia e Medicina Trasfusionale, San Giovanni Calibita Fatebenefratelli Hospital, AFAR, Rome.
Transfusion. 2011 Oct;51(10):2244-56. doi: 10.1111/j.1537-2995.2011.03116.x. Epub 2011 Mar 29.
Obstetric hemorrhage is a leading cause of maternal and perinatal mortality worldwide. Intraoperative blood salvage is common practice in many surgical specialties but its safety in obstetrics is questioned for concerns on the risks of contamination of recovered blood with amniotic fluid (AF) and of maternal-fetal alloimmunization. However, the role of cell salvage as a blood-saving measure in obstetrics is progressively acquiring relevance thanks to the growing body of evidence regarding its quality and safety coming from over 800 documented procedures and more than 400 patients transfused with saved blood. Although the information about the outcomes of the patients treated and the allogeneic blood saving effect are still limited, modern cell savers remove most particulate contaminants and leukoreduction filtering of salvaged blood (SB) before transfusion adds further safety to this technique. Moreover, AF embolism is no longer regarded as an embolic disease and it is suggested that it is a rare anaphylactoid reaction to the fetal antigen. The contamination of the SB by fetal Rh-mismatched red blood cells (RBCs) can be dealt with using RhIG; ABO incompatibility tends to be a minor problem since ABO antigens are not fully developed at birth. Antibodies can be formed against other fetal RBC antigens, but it should also be noted that the risk of alloimmunization of the mother from allogeneic transfusion is probably even greater. Therefore, intraoperative cell salvage in obstetrics should be considered in patients at high risk for hemorrhage or in cases where allogeneic blood transfusion is difficult or impossible.
产科出血是全球孕产妇和围产儿死亡的主要原因。术中血液回收在许多外科专业中是常见的做法，但由于担心回收的血液被羊水（AF）污染以及母婴同种异体免疫的风险，其在产科中的安全性受到质疑。然而，由于越来越多的证据表明其质量和安全性，细胞回收作为一种节省血液的措施在产科中的作用逐渐得到重视，这些证据来自 800 多份有记录的手术和 400 多名接受储存血液输血的患者。尽管关于接受治疗的患者的结果和异体血液保存效果的信息仍然有限，但现代细胞回收器可去除大部分颗粒污染物，对回收的血液（SB）进行白细胞减少过滤，进一步提高了该技术的安全性。此外，AF 栓塞不再被认为是栓塞性疾病，据认为它是对胎儿抗原的罕见过敏反应。可以使用 RhIG 来处理 SB 被胎儿 Rh 不合型红细胞（RBC）污染的问题；ABO 不相容通常是一个较小的问题，因为 ABO 抗原在出生时尚未完全发育。可能会针对其他胎儿 RBC 抗原形成抗体，但也应该注意到，来自异体输血的母亲同种免疫的风险可能更大。因此，在有大量出血风险的患者或异体输血困难或不可能的情况下，应考虑在产科中进行术中细胞回收。
