Autologous Transfusion

DR. NIPPUN PRINJA

CONTENT DEFINATION TYPES & TECHNIQUE ADVANTAGES DISADVANTAGES INDICATIONS COMPLICATIONS SUMMARY

Autologous transfusion is the collection and subsequent

reinfusion of patient’s own blood or blood components

TYPES Preoperative collection

Perioperative collection• Acute normovolemic hemodilution• Intraoperative collection• Postoperative collection

Preoperative collection Blood is collected and stored prior to anticipated

need. Perioperative collection and administration

Acute normovolemic hemodilution: Blood is collected at the start of surgery and then infused during or after the procedure.

Intraoperative collection: Shed blood is recovered from the surgical field or circulatory device then infused.

Postoperative collection: Blood is collected from the drainage devices and reinfused to the patient.

Advantages

1 Prevent TTDs2 Prevent red cell allo-immunization3 Provide solution to patients with allo-

antibodies4 Prevent adverse transfusion reactions5 Provides fully compatible blood in pts.

With rare blood groups6 Supplements the blood supply in BTS7 Provide solution to religious belief

(Jehovah's witness)

Disadvantages

1- Does not alter risk of bacterial contamination

2- Wastage of blood, if not switched over3- Chances of unnecessary transfusion 4- Subjects patient to perioperative anemia & postoperative anemia(chronic)

Preoperative Autologous Blood Collection Should be stable patients who are

scheduled for a surgical procedure in which blood transfusion is probable. Such as major orthopedic procedures, vascular surgery,

cardiac or thoracic surgery and radical prostatectomy

Donor Criteria

Age – No age limits exist.

Weight – No strict weight limits exist. Must adjust volume of anticoagulant for donors under 50 Kgs(N=14ml/100ml)

Hemoglobin and hematocrit – Hemoglobin should not be less than 11.0 gm/dl and hematocrit not less than 33%

Donor Criteria

Frequency – Collection done at an interval of 7 days the final donation completed at least 3 days before surgery.

Medical History – Should be tailored to the needs of the donor. Such as questions about medications, associated medical illnesses and cardiovascular risk factors.

Blood Bag Labeling

Must be labeled: “Autologous Donor” If any testing is reactive on a current collection or

within the last 30 days it must also be labeled “Biohazard”

Untested autologous units must be labeled “Donor Untested”

If the blood tested negative within the last 30 days it must be labeled “Donor Tested Within the last 30 Days”.

Autologous Sticker

Supplemental Iron Supplemental iron should be prescribed

by the requesting patients physician Ideally prescribed before the collection

of the first unit with sufficient time to allow for the patients marrow to reconstitute all or a significant portion of the donated RBC volume.

Collection Request is made in writing by the requesting

patients Physician Request form is kept in the collecting facility

Should include name, unique identification number, number of units, surgical procedure, and physicians signature.

Schedule of Blood Collections Depends on the number of units requested As far ahead of the scheduled surgery as

possible.

How to collect Autologous Blood

Leap Frog Technique On day 0: unit A withdrawn On day 7:unit B & C are withdrawn and unit a is

retransfused On day14: unit D & E are withdrawn and unit b is

retransfused On day 21: unit F & G are withdrawn and unit c is

retransfued So now unit D,E,F,G are present with us which can

be given to patient when needed

Pre-op Autologous DonationContraindications:1 Evidence of infection and risk of bacteremia2 Scheduled surgery to correct aortic stenosis3 Unstable angina4 Active seizure disorder5 Myocardial infarction or CV accidents6 Significant cardiac or pulmonary disease7 Cyanotic heart disease8 Uncontrolled hypertension9 Bleeding Diathesis

Acute Normovolaemic Haemodilution (ANH)

Acute normovolaemic haemodilution refers to the removal of blood from the surgical patient immediately before or just after the induction of anaesthesia, and its replacement with asanguinous fluid.

No predonation, donation is done at the time of surgery, and the lost volume is replaced by crystalloids or colloids

17

ANH-Advantages Provides fresh whole blood for transfusion. No biochemical alterations associated with storage. Removed blood is kept in the OR in room temperature, so no chance of hypothermia Platelet function is preserved No reduction in oxygen carrying capacity RBC loss during surgery is less as it is diluted with asanguinous fluid Haemodilution decreases blood viscosity , which improves tissue perfusion

18

ANH – Patient selection

Any patient with an adequate haemoglobin (12gm) who is expected to lose 1000ml of estimated blood volume

Both children & elderly can donate, the overall health status of the patient is more important than the chronological age

Patients for general, cardiac, vascular, spine, orthopaedic, obstretric & plastic surgeries are good candidates

Jevohah’s witness patients also agree to ANH

19

ANH - Contraindications

Anaemia Hb < 9gm/dl Decreased renal function is a

relative contraindication, because the excretion of diluent fluid may be impaired

Severe CAD, carotid artery disease, severe pulmonary dysfunction are relative contraindications

20

ANH - Technique

Label with pt’s name , CRnumber, time of removal and is numbered as 1, 2 sequentially.

Kept inside the same operating room. At the room temperature

Blood is re-infused after major blood loss or sooner if indicated

The units are re-infused in the reverse order of collection, so that the first unit which has the high Hct and most clotting factors is administered last.

21

ANH- Complications. Myocardial ischemia and Cerebral hypoxia

are the major potential complications, but are very rare in usual circumstances.

22

INTRA & POST OP BLOOD SALVAGING

With the use of special equipments the blood is collected from the operative field and draining sites. Recovered blood is mixed with anticoagulant is collected in a reservoir with a filter. The filtered blood is then washed with saline. The RBCs suspended in the saline are then pumped into a re-infusion bag. Most of the WBCs, platelets, clotting factors, cell fragments and other debris are eliminated. Several automated devices are available for use.

23

Characteristics of processed blood HCT of processed blood is 50 – 60%

and can be varied by altering the processing parameters.

Oxygen transport properties and survival of RBCs are equal or superior to stored allogenic blood.

Processed blood has a high 2,3-DPG level.

pH of salvaged blood is alkaline, and potassium and sodium levels are normal.

24

Indications Cardiovascular Surgery Ruptured spleen or liver Ruptured ectopic pregnancy Ruptured aneurysm Traumatic penetrating

injuries

Complications

Air embolism and fat embolism are important complications.

Renal dysfunction is a possibility due to the presence of free Hb and Fragmented RBCs.

Sepsis is another serious problem. Presence of tumor cells in the operative

field is considered as a relative contraindication, but experience with many genitourinary tumors indicate that it is acceptable.

26

SUMMARY Autologous transfusion can significantly

decrease transfusion. Appropriate to employ several blood

conservation techniques. In appropriative cases pre-donation is

beneficial. ANH is beneficial for providing fresh blood. Routine use of intra & post op blood

salvage is not justified. Newer processing devices may improve cost-effectiveness

27

28