Debris elimination from partially-filled cell salvage bowls.

Centrifuge-based cell salvage and washing systems, available since the 1970s, have decreased the use of allogeneic blood transfusions (1). Although intraoperative salvage and autotransfusion avoids the risks of allogeneic transfusion, case reports document adverse reactions to this blood, potentially related to inadequate washing (2). The cleanliness of partially filled cell salvage bowls has been questioned. Manufacturers of cell salvage devices vary in their recommendations regarding these bowls because of this concern about wash efficiency (3,4). Both discarding this blood and transfusing after a double-volume wash have been recommended. At least one company has reported that discarding this blood may be unnecessary and has recommended washing with 2000 mL of normal saline, rather than the usual 1000 mL (Haemonetics Corporation, written communication, 1996). However, this unpublished data reported only free hemoglobin (Hb) and residual heparin concentrations and ignored potentially harmful debris, including activated leukocytes (WBCs), platelets (Plts), and anaphylatoxins (C3a and C5a) (5,6). Furthermore, free Hb alone may not be significant when compared with other toxins (7). Also, the manufacturer’s data did not define the level of debris remaining after a single wash volume. This study was designed to measure the residual concentrations of potential toxins after a single wash volume to help assess the safety of transfusing partially filled bowls.