Autoapheresis and intraoperative blood salvage in oncologic surgery

Transfusion of predeposit or salvaged autologous blood has continued to gro w since the 1980s. Issues such as the indications for use and cost effectiv eness as well as the safety of autologous blood salvaged during cancer surg ery have emerged and should be addressed. The concern for possible contamin ation of autologous RBC with cancer cells responsible for metastasis has li mited the use of autologous salvaged blood in cancer patients. Nevertheless , clinical experience has been gained on the use of salvaged blood in patie nts with colorectal, gastric, renal, hepatic, breast, bladder and lung canc er. No evidence has been reported showing an increase in metastasis or a de crease in patient survival, in spite of the obvious demonstration that salv aged blood is contaminated with viable tumor cells which are not washed out of the RBC layer during intraoperative blood salvage (IOBS). However, a number of limitations have hampered the widespread use of IOBS i n these patients and the technique is not well established. Increasing know ledge of the deleterious effects of allogeneic blood transfusion both in te rms of the increased number of viral or bacterial infections and the down-r egulation of the patient's immune system have recalled attention to IOBS an d to the techniques such as filtration, which might reduce the risk of rein fusion of cancer cells, or totally eliminate the risks such as irradiation has been proposed by Hansen's group. This paper reviews the topic with some emphasis on our personal experience with gamma and X-ray irradiation of sa lvaged blood in a large reference hospital: where IOBS and filtration of sa lvaged blood were established for use in cancer patients in 1993 and 1996. (C) 1999 Elsevier Science Ltd. All rights reserved.