Todd: We have a standard protocol that we use for high risk blood loss in pregnancy that we developed with Dr. Waters if you would like it. As Mary Ann said it does not specifically cover ectopic pregnancy but cellsaver use in pregnancy in general. The reason it is not indicated in pregnancy is not because of the problems associated with amniotic fluid embolus, etc but because the company has never pursued the indication. The thought of amniotic fluid embolus is a theory and in the 360 or so articles in the literature on cell salvage in delivery this has never occurred. When I talked with Dr. Waters he said that the studies would never be done because it would take about 1 million patients to do the study in order to have a significant result. If you add a leukocyte depletion filter to your infusion then the risks of amniotic fluid embolus are almost nil. Not any greater than the exposure to amniotic fluid in a regular pregnancy.
Elora Thorpe RN

__________________
Elora Thorpe RN BSN
Coordinator
Blood Conservation Program
St. Luke's Hospital of Kansas City
Kansas City, MO. 64111
816-932-6183

Todd:
I spoke with the OB department yesterday regarding this question and they brought up a good point regarding this issue. Since the patient had an ectopic pregnancy (depending on exactly where the ectopic pregnancy is) then the cell saver should be OK because the reason for contraindication is because of possible amniotic fluid embolus and if the pregnancy is in the tube then there is no amniotic fluid yet so it should not be a problem. When the cellsaver is used in delivery they are treating bleeding not pregnancy so they should differentiate between them.
Elora Thorpe RN

__________________
Elora Thorpe RN BSN
Coordinator
Blood Conservation Program
St. Luke's Hospital of Kansas City
Kansas City, MO. 64111
816-932-6183

One question in using the cell saver at ectopic: what about throphblastic cells and parts of the fetus and their "foreign" proteins?

Elora - if you are willing would I be able to have a copy of the protocol. It sounds interesting and was a topic of discussion recently at our facility. My fax number is 402-449-4551.

Elora: If possible, I would like a copy of that protocol. You are so on top of things. If this cannot be done, I understand. My fax is 706-721-1770. Thanks

Walt

Sorry to get involved in the discussion so late. I guess I need to check the threads more often. Enjoyed everyone's responses as well. There was an impressive report out of the OB/GYN dept. at the University of Texas Health Science Center in San Antonio, Texas. 38 patients with ruptured ectopic pregnancy who recieved intraoperative autotransfusion without any adverse events. If you would like to read the article or have it available it is : Merrill SB.et al. The Journal of Reproductive Medicine, Vol. 24, No. 1/ January 1980, pages 14-16. It's an older study, but I think if used in collaboration with Dr. Water's data you have a pretty convincing arguement

Joe Thomas RN