OB EPO Use & Blood Salvage at CS (IOCS)

Respect for patient autonomy is a fundamental part of the clinician-patient relationship and discussion of healthcare interventions. Some patients decline transfusion of blood products, either for religious or non-religious reasons, but most frequently as part of the Jehovah’s Witness faith. Acceptance of, and decision-making, surrounding blood products and human blood derived medications is complex, however, and some patients who decline certain blood products may still accept other interventions. Because childbirth can be associated with excess blood loss and need for resuscitation, it is important before delivery to clearly delineate which blood products will be accepted or declined, realizing that the patient can change her preferences at any time. One way proposed to address blood loss at cesarean section is the use is intraoperative cell saver (IOCS) for autologous infusion (re-infusion of blood). Is it appropriate to use cell savers to collect and re-infuse blood during a C-section? Does ACOG mention this as an option? And what about the use of erythropoietin antepartum to increase RBC capacity? These questions are the focus of this episode.