To the Editor:-Green [1] is to be commended for his enthusiastic endorsement of procedures long used by anesthesiologists to decrease the transfusion of allogenic (homologous) blood perioperatively. Caution, however, should be exercised in accepting his suggestion that anesthesiologists extend their efforts to assuming total responsibility for perioperative cell saving.

When preparing his American Association of Blood Banks (AABB)-mandated quality control program, Dr. Green may have been unaware of the AABB Guidelines for Blood Salvage and Reinfusion in Surgery and Trauma [2] subsequently endorsed by the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel on the Use of Autologous Blood, which specifies the staffing requirements for operating cell-washing devices. The NHLBI document states:“It is essential to have a trained, dedicated operator to operate the equipment, even the newer, automated models.”[3] The operation of the cell-saving apparatus, like the administration of an anesthetic, demands one's undivided, uninterrupted attention. This may preclude Green's suggestion that:“it is possible, in certain cases, to perform the anesthetic and operate the autotransfusion machine simultaneously.”

Anesthesiologists should carefully consider the financial aspects of assuming responsibility for a cell-saving operation. Although Dr. Green may have saved the US Air Force $15,000–20,000 in the first year of service, such savings may not extend to other situations. Many large institutions already use perfusionists or anesthesia technicians who are trained to operate cell savers, and others have contracts for the provision of such services. The cost of these services may be reimbursable as a portion of the overall cost of operating the facility. There may, therefore, be no real dollar saving to the institution. When such a pass-through is not permissible, a group of anesthesiologists should consider the worth of such “value added” service in relation to the commitment required (providing around-the-clock coverage) for minimal financial return. In addition, the potential of increased exposure to liability claims must be considered.

Howard L. Zauder, M.D., Ph.D.

Chairman, Anesthesia Section; Carl T. Hayden Veterans Affairs Medical Center; Phoenix, Arizona 85012

(Accepted for publication April 25, 1997.)


Green DM: Perioperative autologous transfusion service: A logical extension of our role in the operating room. Anesthesiology 1997; 86:258.
Guidelines for Blood Salvage and Reinfusion in Surgery and Trauma. Bethesda, American Association of Blood Banks, 1993.
National Heart, Lung, and Blood Institute Expert Panel on the Use of Autologous Blood: Transfusion alert: Use of autologous blood. Transfusion 1995; 35:703-11.