Impact of Cell Saver technology on pro-hemostatic factors transfusion in placenta accreta spectrum interventions: A 10-year retrospective single-center study

Ilan Levy; Maud Vachette; Emma Van Der Putten; Marine Chouteau; François Goffinet; Catherine Fischer; Aude Girault; Yoann Athiel

doi:10.1002/ijgo.71181

Impact of Cell Saver technology on pro-hemostatic factors transfusion in placenta accreta spectrum interventions: A 10-year retrospective single-center study

Int J Gynaecol Obstet. 2026 Jul 2. doi: 10.1002/ijgo.71181. Online ahead of print.

Authors

Ilan Levy¹, Maud Vachette¹, Emma Van Der Putten², Marine Chouteau², François Goffinet¹, Catherine Fischer², Aude Girault¹, Yoann Athiel¹

Affiliations

¹ Department of Obstetrics and Gynecology, Port-Royal Maternity, Université Paris Cité, APHP, Paris, France.
² Department of Anesthesia, Port-Royal Maternity, Cochin Hospital, Université Paris Cité, APHP, Paris, France.

PMID: 42394398
DOI: 10.1002/ijgo.71181

Abstract

Background: While Cell Saver technology effectively reduces red blood cell transfusion in the perioperative setting, its impact on the need for pro-hemostatic factors remains unclear. The use of Cell Saver could impact the requirements of pro-hemostatic factors.

Objective: This study assesses whether the use of Cell Saver influences transfusion requirements for fresh frozen plasma, platelet concentrates, and fibrinogen in surgeries for placenta accreta spectrum (PAS) disorders.

Methods: This retrospective, single-center, before-and-after study was conducted in a tertiary maternity hospital. Women undergoing surgery for PAS (cesarean delivery with conservative treatment or hysterectomy) were included. Two periods were compared: before (2013-2017, Period A) and after Cell Saver implementation (2019-2023, Period B), with a 1-year washout (2018). The primary outcome was a composite criterion: transfusion of ≥ 3 units of FFP (fresh frozen plasma) and/or ≥ 1 unit of PC (platelet concentrates) and/or ≥ 4 g fibrinogen. Univariate and multivariable logistic regression analyses were conducted, with subgroup analyses in women undergoing hysterectomy and those with blood loss ≥ 2000 mL.

Results: Among 136 women (69 in Period A, 67 in Period B), Cell Saver was used in 86% of Period B cases (median volume: 769 mL). The primary outcome occurred in 42% of Period A versus 52.2% of Period B (P = 0.23). However, multivariable analysis showed lower odds of pro-hemostatic transfusion with Cell Saver use (adjusted odds ratio 0.21; 95% confidence interval 0.06-0.77). In patients with ≥ 2000 mL blood loss, the primary outcome was significantly less frequent in Period B (71.1% vs. 95.6%, P < 0.05).

Conclusion: Cell Saver use during PAS surgery is independently associated with reduced pro-hemostatic transfusion, especially in cases with major bleeding, supporting its routine use.

Keywords: blood salvage; cell saver; placenta accreta; pro‐hemostatic factor; transfusion.