Which of the following is the MOST accurate statement regarding cell salvage (intraoperative autotransfusion) during surgery?

• A Contraindicated in all cancer surgeries due to risk of metastatic dissemination
• B The salvaged blood has the same composition as fresh whole blood including viable platelets and coagulation factors
• C Returns washed packed red blood cells with haematocrit 50–70%; can be used in malignancy if leucocyte depletion filter is added ✓
• D Absolutely contraindicated in obstetric cases due to amniotic fluid contamination

Explanation

Cell salvage washes and concentrates red blood cells from the operative field, returning a product with haematocrit of approximately 50–70% and minimal plasma, platelets, coagulation factors, or activated cytokines. It is NOT whole blood equivalent — recipients may require FFP and platelets separately. Traditional contraindication in malignancy is based on theoretical metastatic spread risk; contemporary evidence and NICE guidelines support its use in cancer surgery with leucocyte depletion (radiation) filters. In obstetrics, early concerns about amniotic fluid embolism have been largely refuted; cell salvage is now accepted in obstetric haemorrhage with leucocyte depletion filter use.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.