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1. AUTOLOGOUS BLOOD
TRANSFUSION IN
ORTHOGNATHIC SURGERY
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INDIAN DENTAL ACADEMY
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2. Introduction :
 Blood - “ RED GOLD ”
 Double - edged tool
 Life saving - Grave threat
 Rationale of using blood
 Limiting factors
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3. Autologous blood transfusion :
Pre operative collection of blood for
Subsequent re infusion into donor
vascular
System at a later time.
 Patient - His own donor
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4. What is the need ?
 Risks of homologous blood
 Undesirable transfusion reactions
 Shortage of blood
 Better understanding
 Benefit - to - risk relationship
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5. Review of literature :
 Neither a new concept nor a technique
 Grant in 1921
 Fantus et al in 1937
 Historical reviews - slow growing process
 Importance - 1980`s
( Int jou Adult Orthod Orthognath Surg, 1992 vol 7 )
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6. Blood transfusion in OMFS :
 Use increased - 2 decades
 Young patients
 Blood loss
 Requirements - intraopeartive
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7. Aims & Objectives :
 Feasibility in orthognathic surgery
 Advantages over homologous transfusio
 Cross infection
 Alloimmunization
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8. Materials & Methods :
 Total no : 12
 Female - 10
 Male - 2
 Age group - 17 to 26 yrs
 Bimaxillary osteotomy
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9. Exclusion criteria :
 Hb less than 11g/dl
 Hematocrit less than 34%
 Hypertension
 Coronary disease
 Pregnancy
 Diabetes
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10. Pre requisite :
 No active infection
 Routine hematological testing
 Blood deposit - 1 week pre op
 1 unit
 Ferrous fumarate 350 mg - surgery
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11. Study :
 Bimaxillary osteotomy
 Blood count
Hb
Ht
RBC count
 Pre op, post donation, day - 1, 7, 30
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12. Results :
 All 12 units transfused
 BP, heart rate, temperature
 Anemia, infection, allergic reactions
 Adjunctive homologous transfusion
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13. Study details :
Pre.op
Blood
loss in
ml
Units
Transfuse
d
Case
s
Age/
Sex
Procedure
case
1
24/F
LF1 & LS
700
case
2
22/F
LF1 & LS
case
3
19/F
case
4
After Blood Donation
Post.op Day 1
Post.op 1Week
Post.op 1Month
Hb
gm/dl
Ht%
RBC in
millions
Hb
gm/dl
Ht%
RBC in
millions
Hb
gm/dl
Ht%
RBC in
millions
Hb
gm/dl
Ht%
RBC in
millions
Hb
gm/dl
Ht%
RBC in
millions
1 Unit
12.5
36
4.16
11.5
34
3.80
11.0
33
3.50
11.0
32
3.40
11.5
35
3.95
650
1 Unit
12.5
40
4.20
11.5
36
3.80
11.0
32
3.30
11.5
34
3.80
12.0
36
4.00
LF1 & AG
450
1 Unit
12.0
38
4.00
11.0
33
3.80
10.0
30
3.00
11.0
34
3.60
12.0
38
4.00
23/F
LF1 & LS
400
1 Unit
11.5
34
3.80
11.0
33
3.30
8.0
24
2.40
10.5
30
3.00
12.0
38
4.40
case
5
26/
M
BSSO,
US & LS
600
1 Unit
12.5
40
4.10
11.6
37
3.80
10.8
33
3.20
11.2
34
3.40
11.5
36
3.80
case
6
19/F
BSSO &
US
475
1 Unit
11.0
34
3.40
10.2
32
3.10
9.0
29
2.80
10.0
30
3.00
10.5
33
3.40
case
7
21/F
LF1 & LS
550
1 Unit
11.0
35
3.50
10.2
32
3.30
9.8
30
3.10
10.5
34
3.40
11.0
35
3.60
case
8
24/
M
BSSO &
US
450
1 Unit
12.5
40
4.20
11.8
38
4.00
11.2
35
3.60
11.8
38
3.90
12.0
38
4.00
case
9
17/F
LF1 & LS
500
1 Unit
11.5
38
3.80
10.8
35
3.40
10.2
33
3.20
10.6
35
3.60
11.0
36
3.80
case
10
21/F
LF1, LS
& AG
400
1 Unit
12.0
38
4.00
10.2
33
3.40
8.8
28
2.90
9.6
29
3.20
10.0
30
3.40
case
11
23/F
LF1 & AG
350
1 Unit
12.0
38
4.00
11.0
36
3.60
10.2
32
3.40
11.0
36
3.50
11.8
40
3.90
case
12
20/F
LF1 & LS
400
1 Unit
12.6
39
4.10
10.8
36
3.60
10.2
34
3.20
11.0
35
3.60
11.8
38
4.00
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14. Statistical analysis :
 TWO WAY ANOVA - variance
 SCHEFFE TEST - post hoc
 Statistical significance 5% - P < 0.05
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15. Statistical analysis :
Period
Parameters
Pre op
Hb gms% Mean
(SD)
Ht%
Mean (SD)
RBC n millions
Mean (SD)
After Donation
Post op
Day 1
Post op 1
week
Post op 1
month
P Value
11.97 a
(0.59)
10.97 b
(0.56)
10.02 a
(0.99)
10.81ab
(0.61)
11.43 bc
(0.66)
< 0.001**
37.50 c
(2.24)
34.58 bc
(2.02)
31.08 a
(3.06)
33.42 ab
(2.68)
36.08 bc
(2.68)
< 0.001**
3.94 c
(0.26)
3.58 bc
(0.27)
3.13 a
(0.33)
3.45 ab
(0.28)
3.85c
(0.28)
< 0.001**
 Since P value is less than 0.01, there is significant difference
between time period’s hemoglobin, hematocrit and red blood cell
counts.
 Based on Scheffe test, there is no significant difference between
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pre operative and postoperative blood parameters

16. Comparative analysis : 1
Changes of mean haemoglobin (Hb)
12
Hb gms %
11.5
11
10.5
10
9.5
9
Pre operative
After Blood
Donation
Post op Day1
Post op 1 Week
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Post op 1
month

17. Comparative analysis : 2
Changes of mean hematocrit (ht)
40
35
Ht %
30
25
20
15
10
5
0
Pre
operative
After Blood
Donation
Post op
Day1
Post op 1
Week
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Post op 1
month

18. Comparative analysis : 3
Changes of mean red blood cell counts (RBC)
4
6
RBC (X10
c/ml)
3.5
3
2.5
2
1.5
1
0.5
0
Pre
operative
After Blood
Donation
Post op
Day1
Post op 1
Week
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Post op 1
month

19. Discussion :
 Four categories
1. Pre operative autologous blood donation
( PABD )
2. Intra operative hemodilution
3. Intra operative blood collection
4. Post operative blood collection
 Wayne et al - PABD - technique of choice
( JOMFS, 1992 )
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20. cont :
 Reduction in blood parameters
 Self correction , supplementary iron
 Widmann - 8 to 1o days
( JAMA, 1995 )
 John Moening - Bimaxillary osteotomy
( JOMFS, 1995 )
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21. cont :
 Current study - improvement in parameters
 Maria Christopoulou et al
( JCMFS, 2001 )
 Neuwirth et al - quicker return of activity
( Int Jor Adult Orthod, 1992, vol 7 )
 Widest applications
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22. Advantages :
No risk of transfusion transmitted disease
Prevents alloimmunization
Stimulate donor erythropoiesis
No need for compatibility testing
Source of blood
No transfusion reactions
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23. Disadvantages :
 Outdating incidence
 Mishandling of units
 Poor storage
 Clerical errors
 Risk of imbalance of autonomic regulation
( Seto et al - JOMFS, 2005 )
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24. WHO :
Donations - 3/1000, 52/1000
5 per hospital bed
Hepatitis B - 300 million carriers
HIV - 33.4 million
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25. Reference : 1
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26. Reference : 2
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27. Autologous blood transfusion :
Safety
Effectiveness
Availability
An effective alternative to homologous blood
Safest blood - his own blood”
Council of scientific affairs, JAMA )
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28. Conclusion :
There are no therapeutic roses without thorns
- Prof. Mollison
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29. THANK YOU
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Leader in continuing dental education
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