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Auto transfusion in military medicine applications
- 1. Auto transfusion in military medicine applications Ebrahim Hazrati(1), Babak Paknejhad(2), Azita Chegini(3), Mohammadreza kosari(4), Mohammadali Sharifi(5), Alireza Rezaei(6) 1-Assistant Professor of Anesthesiology Department of AJA University of Medical Sciences, Imam Reza Hospital, Tehran, Iran 2-Assistant Professor of Toxicology-pharmacology department, faculty of medicine, AJA University of Medical Sciences, Tehran, Iran 3-Assistant professor of Blood Transfusion Research center, High Institute for research and Education in transfusion medicine, Tehran, Iran 4-Assistant professor of Neurosurgery department, faculty of medicine, AJA University of Medical Sciences, Tehran, Iran 5-Master of Engineering Project Management, faculty of Engineering, The University of Auckland, Auckland, New Zealand 6-Master of Medical engineering, Department of Nano Technology and Advanced Materials, Material and Energy Research Center, Karaj, Iran Electronic Virtual Code: A-10-644-01
- 2. Introduction: Challenges of blood transfusion in military medicine Auto transfusion in military medicine applications • The Challenges of the blood transfusion in military medicine – Blood supply chain management: The five major elements (collection, processing, storage, shipping, and transfusion activities) – Blood Cost: Additional safety measures add costs to blood products – Patient Safety: Blood transfusion introduces patient risk • Correlated to increased viral and bacterial infections • Longer length of stay (LOS) • Increased incidence of adverse reactions Blood supply chain management Patient Safety Blood Cost • Successful blood support for future conflicts will require : – The agility in thought – Creative solutions – Full array of blood and blood safety products and devices for the health care of armed forces
- 3. Introduction : Auto transfusion Auto transfusion in military medicine applications Auto transfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. avoiding or reducing complications such as transmission of infection agent Eliminates clerical errors Minimizes Immunosuppressive effect of allogenic blood Immediate availability of blood for patient Is truly cost effective Why auto transfusion?
- 4. Type of Auto transfusion in Military medicine & emergency Applications Auto transfusion in military medicine applications Pre-Operative Blood transfusion (Blood recycling) Acute Normo-volomic Hemodilution (ANH) Intra & post Operative blood salvaging • Shed blood collection on the battlefield of the patient and whole blood back to Patient. • Immediately before and after induction of anesthesia 1-3 unit blood removed and replace with Crystalloid or collide. • Shed blood is Collected from operative field and draining site and re-infused into the patient after processing. Then washed RBCs back to patient.
- 5. Indication and risks Auto transfusion in military medicine applications 01 02 03 Anticipated blood loss of >1000 ml or >20% estimated blood volume Patients with a low hemoglobin or at increased risk of bleeding patients with multiple antibodies or rare blood types 04 patients with objections to receiving allogeneic blood AAGBI guidelines identified indications for the use of intraoperative cell salvage: Pelvis 3 000 mL Femur 1 000 mL Tibia 650 mL Abdominal injury 2 000 – 4 000 mL Thoracic injury 2 000 – 4 000 mL Estimated blood loss in trauma
- 6. Type of the Intra or post Operative cell salvage Auto transfusion in military medicine applications •Base centrifuge theory and Latham bowl system •the bleeding must be predicted then centrifuge bowl is chosen (You have to choose between 3 sizes) – ( If wrong size has been chosen auto transfusion will be interrupted) •Discontinues procedure •Hard spin centrifugation causes lyse in erythrocytes Discontinuous Since 1976 • Base centrifuge theory • Continuous procedure – Non interruptive • soft spin centrifugation protect the cells Continuous Since 1995 Intake Waste out put
- 7. Conclusion Auto transfusion in military medicine applications supply chain management, the management of supply and demand adaptation, logistic load, possible consequences of allogeneic blood transfusion, blood cost and etc., of the challenges of military medicine. Successful blood support for future conflicts will require: The agility in thought, Creative solutions, Full array of blood and blood safety products and devices for the health care of armed forces The aim of cell salvage is to reduce or eliminate the need for allogeneic blood transfusion and the associated risks of infectious and non- infectious complications and the blood supply chain management can be facilitated in the field of battle.
- 8. In Iran, little cost is received for a unit of blood ... But the cost of treatment for the complications of allogeneic blood transfusions has not yet been calculated ...! " Thank you for watching • Sikorski, R. A., et al. "Autologous blood salvage in the era of patient blood management." Vox sanguinis 112.6 (2017): 499-510 • Ashworth, A., and A. A. Klein. "Cell salvage as part of a blood conservation strategy in anaesthesia." British journal of anaesthesia 105.4 (2010): 401-416. • Spinella, Philip C., et al. "Constant challenges and evolution of US military transfusion medicine and blood operations in combat." Transfusion 52.5 (2012): 1146-1153. • Gourlay, Terence, C. Simpson, and C. A. Robertson. "Development of a portable blood salvage and autotransfusion technology to enhance survivability of personnel requiring major medical interventions in austere or military environments." Journal of the Royal Army Medical Corps (2017): jramc-2017. • Zhou, J. "A review of the application of autologous blood transfusion." Brazilian Journal of Medical and Biological Research 49.9 (2016) • Haider, Adil H., et al. "Military-to-civilian translation of battlefield innovations in operative trauma care." Surgery 158.6 (2015): 1686-1695 • Goodnough, Lawrence T., et al. "Transfusion medicine—blood transfusion." New England Journal of Medicine 340.6 (1999): 438-447.
Editor's Notes
- Blood transfusion is a vital element in the surgery management especially in the battlefield which often requires high volume of blood products. Blood components are valuable products which even in peace terms, supply chain management had challenged governments' health systems. Additionally, the management of supply and demand adaptation, logistic load, possible consequences of allogeneic blood transfusion, blood cost and etc., were among the important challenge in supplying and transferring blood in the battlefield. Successful blood support for future conflicts will require the agility in thought, creative solutions, and a full array of blood and blood safety products and devices for the health care of armed forces. The active engagement in the advanced development of blood products and efforts to improve blood safety are paramount today and in the future.
- Auto transfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogeneic. The first documented use of "self-donated" blood was in 1818, and interest in the practice continued until the Second World War, at which point blood supply became less of an issue due to the increased number of blood donors. Later, interest in the procedure returned with concerns about allogeneic transfusions. During the American Civil War Union Army physicians are said to have administered four transfusions. In 1886, J. Duncan used auto transfusion during the amputation of limbs by removing blood from the amputated limb and returning it to the patient by femoral injection. This method was apparently fairly successful. A German, M. J. Theis, reported the first successful use of intraoperative autotransfusion in 1914, with a ruptured ectopic pregnancy. The earliest report in the American literature on the use of autotransfusion was by Lockwood in 1917 who used the technique during a splenectomy for Banti syndrome. In 1976, this system was introduced by Haemonetics Corp. and is known commonly as "Cell Saver“. More recently in 1995 Fresenius introduced a continuous autotransfusion system. Why auto transfusion? avoiding or reducing complications such as transmission of infection agent Eliminates clerical errors Minimizes Immunosuppressive effect of allogeneic blood Immediate availability of blood for patient Is truly cost effective
- Type of the Auto transfusion in Military medicine & emergency Applications include : Pre-Operative Blood transfusion (Blood recycling) Acute Normo-volomic Hemodilution (ANH) Intra & post Operative blood salvaging In Blood recycling Shed blood collection on the battlefield of the patient and whole blood back to Patient. In Acute Normo-volomic Hemodilution Immediately before and after induction of anesthesia 1-3 unit blood removed and replace with Crystalloid or collide. And in Intra & post Operative blood salvaging Shed blood is Collected from operative field and draining site and re-infused into the patient after processing. Then washed RBCs back to patient. There are three phases involved in cell salvage—collection, washing, and re-infusion. Collection of red blood cells (RBCs) from the operative field requires the use of a double-lumen suction device. One lumen suctions blood from the operative field and the other lumen adds a predetermined volume of heparinized saline to the salvaged blood. The anti coagulated blood is then passed edicated through a filter and collected in a reservoir. Separation of the components is achieved by centrifugation. he RBCs are then washed and filtered across a semi-permeable membrane, which removes free haemoglobin, plasma, platelets, white blood cells, and heparin.
- The aim of cell salvage is to reduce or eliminate the need for allogeneic blood transfusion and the associated risks of infectious and non-infectious complications. The 2009 AAGBI guidelines identified indications for the use of intraoperative cell salvage: anticipated blood loss of more than 1000 ml or more than 20% estimated blood volume, patients with a low hemoglobin or at increased risk of bleeding, patients with multiple antibodies or rare blood types, and patients with objections to receiving allogeneic blood. There are many potential complications associated with cell salvage, such as non-immune hemolysis, febrile non- haemolytic transfusion reactions, coagulopathy and etc. They found the incidence of adverse events with auto transfusion to be 0.027% compared with 0.14% with allogeneic blood transfusion
- supply chain management, the management of supply and demand adaptation, logistic load, possible consequences of allogeneic blood transfusion, blood cost and etc., of the challenges of military medicine. Successful blood support for future conflicts will require: The agility in thought, Creative solutions, Full array of blood and blood safety products and devices for the health care of armed forces The aim of cell salvage is to reduce or eliminate the need for allogeneic blood transfusion and the associated risks of infectious and non-infectious complications and the blood supply chain management can be facilitated in the field of battle.