In which of the following circumstances would the use of the cell-saver be contraindicated?

The use of a cell-saver is contraindicated in the case of contamination of blood from the bowel because it can lead to the reinfusion of contaminated blood. The cell-saver collects and processes blood lost during surgery so that it can be reinfused into the patient. However, if the blood is contaminated with gastrointestinal contents, such as bacteria or toxins, using that blood could pose significant risks for serious infections and other complications upon reinfusion.

In situations of massive hemorrhage, pelvic surgery, or plastic surgery, while careful consideration and protocols are involved, these scenarios do not inherently contraindicate the use of a cell-saver. Instead, they often still allow the use of cell-savers under specific conditions that minimize risks. For example, in pelvic surgery, if the area is properly managed, salvaged blood can still be safe. Similarly, massive hemorrhage may require the use of the cell-saver to reduce the need for allogeneic blood transfusions, provided the blood collected is not contaminated. In plastic surgery, where blood loss may be significant but not contaminated, a cell-saver can also be beneficial.