Intraoperative cell salvage for surgeries with anticipated or possible significant blood loss

Guidance Recommendations

The Ministry of Health’s Medical Technology Advisory Committee has recommended intraoperative cell salvage (ICS) for patients undergoing surgery, in line with the following criteria:

• Where significant blood loss is expected, as well as in emergency situations where unexpected significant blood loss occurs; and

• The decision to perform ICS shall be made by a multidisciplinary team, including the surgeon and anaesthetist (and other specialists if needed), who will ascertain patient suitability by considering various factors, such as whether the anticipated blood loss meets the minimum blood volume required to initiate blood processing using ICS.

Clinicians can consider using the Massive Transfusion Protocol (MTP) and maximum allowable blood loss (MABL) formula to guide decision on patient suitability.

ICS should be used concurrently with other patient blood management measures such as optimising pre-operative haemoglobin and minimising bleeding risks with surgical, anaesthetic or pharmacological techniques.

The use of ICS including its risks and benefits should be discussed with the patient or substitute decision maker, especially in instances where its use may be a concern, such as the presence of sepsis or malignancy.

Funding status

ICS is recommended for subsidy for patients undergoing surgeries with anticipated or possible significant blood loss, in line with the abovementioned recommendations.

Intraoperative cell salvage for surgeries with anticipated or possible significant blood loss (Published 1 Sep 2025)