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Implementation of quality management in intraoperative blood salvage with controls of product and process quality supports early recognition and repair of dysfunction if respective actions are laid down in the quality management handbook. In order to avoid insufficient quality and to improve process quality, a broad understanding of the processes and of the variables affecting quality is needed, which is based on experimental tests. For this purpose the use of fresh whole blood as test blood and of protein as parameter for determination of the plasma elimination rate is favorable over outdated banked blood and free hemoglobin. Tested this way, the process of blood collection by suction is by far not as harmful to RBCs as expected. Partially filled bowls, lower wash volumes, or a fastened filling or washing should be avoided. Plasma washout can be improved by higher wash volumes or by slower filling and washing, which avoids increased loss of RBCs. Quality management which is based on a better understanding of the procedure as well as quality controls can help to supply high-quality blood for optimal hemotherapy by blood salvage.

Because of a still growing demand for blood which is contrasted by a decreasing number of donations and because of multiple transfusion risks, it is necessary to consider intraoperative blood salvage also in cancer surgery. In this context blood irradiation is essential for the elimination of contaminating tumor cells. As demonstrated by growing usage, a combination of two established techniques is a feasible approach for this procedure. With respect to increasing costs of banked blood it is highly cost-effective. The efficacy of blood saving is evident while its impact on the outcome of the patients awaits verification. Blood irradiation is safe in providing efficient elimination of proliferating cancer cells that contaminate blood, and in not damaging the red blood cells (RBC). Quality of these washed and irradiated fresh RBC is superior to banked blood by unimpaired function and viability. The legal aspects of intraoperative blood salvage with blood irradiation need clarification to allow unhindered application of this useful method for optimal hemotherapy in cancer patients.

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The demand for intraoperative blood salvage (IBS) in cancer surgery originates from the high transfusion rate, the unfavorable effects of anemia, and the special impact of transfusion risks such as immunomodulation in tumor patients. The advantages of IBS are availability, low waste rate, and excellent quality of the autologous, unstored blood. Effective elimination of tumor cell dissemination by retransfusion of wound blood can be achieved only by blood irradiation. Combining established methods of IBS and blood irradiation is feasible and allows efficient saving of blood. For Jehovah’s witnesses it may open the option of tumor surgery. From an anesthesiological point of view IBS blood is not a drug but part of the therapy. Even if it is viewed as drug, practical medicolegal regulations are in sight. IBS with blood irradiation provides the safest and best blood for optimal hemotherapy in tumor patients. In addition, first data indicate a better outcome of patients in whom IBS was performed.