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  1. 1. AUTO TRANSFUSIONAUTO TRANSFUSION Dr. Lokesh SharoffDr. Lokesh Sharoff
  2. 2.  Also known as Autologous transfusionAlso known as Autologous transfusion  Defined as the collection and reinfusion ofDefined as the collection and reinfusion of patients own blood / blood componentspatients own blood / blood components  Safest form of blood transfusionSafest form of blood transfusion  More cost effective than allogenicMore cost effective than allogenic transfusiontransfusion
  3. 3. HISTORYHISTORY  First Autologous transfusion was done byFirst Autologous transfusion was done by James Blundell in 1818 before theJames Blundell in 1818 before the discovery of blood groups.discovery of blood groups.  Anglo-saxon was the first to publish anAnglo-saxon was the first to publish an article reporting Autotransfusion in 1874.article reporting Autotransfusion in 1874.  Blood salvage was first reported inBlood salvage was first reported in American literature in 1917.American literature in 1917.  In 1974 Cell saver system was introducedIn 1974 Cell saver system was introduced
  4. 4. ADVANTAGESADVANTAGES  Avoidance of complications associated withAvoidance of complications associated with allogenic transfusion like:allogenic transfusion like:  Acute and delayed hemolytic reactions due to ABOAcute and delayed hemolytic reactions due to ABO incompatibilityincompatibility  Allo-immunizationAllo-immunization  Allergic and febrile reactionsAllergic and febrile reactions  Transfusion transmitted infectious diseases like HIV,Transfusion transmitted infectious diseases like HIV, Hep-B and Hep-C, EBV, cytomeglo virus, malaria andHep-B and Hep-C, EBV, cytomeglo virus, malaria and filaria.filaria.  Immuno suppressionImmuno suppression
  5. 5.  Conservation of blood resources.Conservation of blood resources.  Patient with rare blood phenotypes arePatient with rare blood phenotypes are benefited.benefited.  Availability- Instantly available andAvailability- Instantly available and requires no cross matching.requires no cross matching.
  7. 7. 3 Types of Autotransfusion3 Types of Autotransfusion 1.1. Pre operative blood donationPre operative blood donation 2.2. Acute normovolemic HemodilutionAcute normovolemic Hemodilution 3.3. Intra operative and post operative bloodIntra operative and post operative blood recovery.recovery.
  8. 8. Pre operative Autologous BloodPre operative Autologous Blood DonationDonation  Done before elective surgical proceduresDone before elective surgical procedures during significant blood loss may occurduring significant blood loss may occur  Patients selectionPatients selection  Hb not less than 11 g/dlHb not less than 11 g/dl  Hematocrit- 33%Hematocrit- 33%  Last transfusion should occur at least 72 hourLast transfusion should occur at least 72 hour before surgery.before surgery.
  9. 9.  Pt with <50 kg can donatePt with <50 kg can donate proportionately lower volume.proportionately lower volume.  Can donate up to 6 units if startedCan donate up to 6 units if started earlier.earlier.  Children less than weighing 65Children less than weighing 65 poundpound  Adolescent requiring surgery forAdolescent requiring surgery for Scoliosis ideal candidate for PABDScoliosis ideal candidate for PABD
  10. 10. ContraindicationsContraindications  Pts with bacteremia/septicemiaPts with bacteremia/septicemia  Pts with unstable angina, CHF and M.IPts with unstable angina, CHF and M.I within previous 6 monthswithin previous 6 months  Pts with procedures which rarely requirePts with procedures which rarely require transfusion should be discouraged.transfusion should be discouraged.  Pre donation not cause harm in obstetricPre donation not cause harm in obstetric patients, but justified only in cases likepatients, but justified only in cases like placenta previaplacenta previa
  11. 11.  CPDA is used as preservativeCPDA is used as preservative  Stored as liquid whole bloodStored as liquid whole blood  Shelf life is 35-42 daysShelf life is 35-42 days  Ferrous sulphate is given to preventFerrous sulphate is given to prevent anemia.anemia. Erythropoietin is given 3-4 weeksErythropoietin is given 3-4 weeks before surgery.before surgery.
  12. 12. ComplicationsComplications  Reaction rate 1.5 to 5.5%Reaction rate 1.5 to 5.5%  More seen in younger donors, women and firstMore seen in younger donors, women and first time donors.time donors.  Ischaemic episodes after donationIschaemic episodes after donation  HypotensionHypotension  ArrhthymiasArrhthymias  ST-T changesST-T changes  SyncopeSyncope  Risk of contaminationRisk of contamination
  13. 13. RBC production depends uponRBC production depends upon Adequate iron storeAdequate iron store No. of units donatedNo. of units donated Frequency of donationFrequency of donation
  14. 14. Acute Normovolemic HemodilutionAcute Normovolemic Hemodilution  It is removal of blood from surgical ptsIt is removal of blood from surgical pts immediately before or just after inductionimmediately before or just after induction of anesthesia, replacement with acellularof anesthesia, replacement with acellular fluid and later reinfusion of withdrawnfluid and later reinfusion of withdrawn blood.blood.  Acute limited/ moderate normovolemicAcute limited/ moderate normovolemic hemodilution – HCT ishemodilution – HCT is ↓↓ 28%28%  Acute extreme normovolemicAcute extreme normovolemic hemodilution HCT ishemodilution HCT is ↓↓ 20%20%
  15. 15. AdvantagesAdvantages  Blood does not undergo biochemicalBlood does not undergo biochemical alterations (likealterations (like ↓↓ 2-3 diphosphoglycerate)2-3 diphosphoglycerate)  No influence on oxygen-Hb disscn curveNo influence on oxygen-Hb disscn curve  Platelet function preserved.Platelet function preserved.  Improvement in tissue perfusion. B/oImprovement in tissue perfusion. B/o decreased viscosity.decreased viscosity.  No iatrogenic anaemia and blood wastageNo iatrogenic anaemia and blood wastage  Simple and less expensiveSimple and less expensive
  16. 16.  When potential bactremia precludesWhen potential bactremia precludes predonation ANH may be ideal solutionpredonation ANH may be ideal solution  Clerical error is eliminatedClerical error is eliminated --RBCs are saved as the blood lost during--RBCs are saved as the blood lost during surgery is diluted is diluted blood.
  17. 17. Physiological EffectsPhysiological Effects  Withdrawal of blood and replacement withWithdrawal of blood and replacement with acellular fluid is accompanied byacellular fluid is accompanied by ↓↓ arterialarterial Oxygen. But Oxygen delivery isOxygen. But Oxygen delivery is unaffectedunaffected  ↑↑ in cardiac outputin cardiac output  ↓↓ in viscosity -in viscosity - ↑↑ venous return -venous return - ↓↓ perper resistance -resistance - ↓↓ afterload.afterload.  ↑↑ in coronary blood flow(due to coronaryin coronary blood flow(due to coronary vasodilatation)vasodilatation)
  18. 18. Patient selectionPatient selection  For any pt with an adequate Hb who isFor any pt with an adequate Hb who is expected to loss more than 25% of bloodexpected to loss more than 25% of blood volumevolume  Depends on overall health status ratherDepends on overall health status rather than chronological agethan chronological age
  19. 19. ContraindicationsContraindications  ↓↓ renal functionrenal function  COPDCOPD  CoagulopathyCoagulopathy  Hepatic disordersHepatic disorders ANH is performed in operating roomANH is performed in operating room following induction of anaesthesiafollowing induction of anaesthesia
  20. 20. Method of blood collectionMethod of blood collection Blood is withdrawn from central large veinsBlood is withdrawn from central large veins or radial artery.or radial artery. Blood is collected in bags withBlood is collected in bags with anticoagulant-citrate-phosphate-dextroseanticoagulant-citrate-phosphate-dextrose Plasma expanders Crystalloids: RL or NS. 3ml infused for every 1ml collected (moves out of intra- vascular compart Colloids: dextran, gelatin, albumin.1ml infused for 1ml blood collected
  21. 21.  V = EBV x [(Ho) – (Hf)/HavV = EBV x [(Ho) – (Hf)/Hav V = Volume to be removedV = Volume to be removed EBV = estimated blood volumeEBV = estimated blood volume Ho = Initial HCTHo = Initial HCT Hf = Minimum allowable HCTHf = Minimum allowable HCT Hav = average HCTHav = average HCT
  22. 22. ComplicationsComplications  Myocardial ischaemiaMyocardial ischaemia  Cerebral HypoxiaCerebral Hypoxia  CoagulopathyCoagulopathy  Peripheral OedemaPeripheral Oedema
  23. 23. Intraoperative blood donationIntraoperative blood donation  It is recovery or salvage of blood shed inIt is recovery or salvage of blood shed in  By – semicontinuous flow centrifugationBy – semicontinuous flow centrifugation  Recovered blood mixed with anticoagulantRecovered blood mixed with anticoagulant and collected in disposal reservoir with a filterand collected in disposal reservoir with a filter  Filtered blood passed into wash bowl withFiltered blood passed into wash bowl with centrifugation of 5000 per minutecentrifugation of 5000 per minute  Washed with salineWashed with saline  RBC’s are pumped in reinfusion bagsRBC’s are pumped in reinfusion bags
  24. 24.  WBC, cell fragments and activated clottingWBC, cell fragments and activated clotting factors are eliminated into waste bag.factors are eliminated into waste bag.  Max. vacuum level 100 to 150 mm of HgMax. vacuum level 100 to 150 mm of Hg  Blood contaminated with intestinalBlood contaminated with intestinal contents should not be reinfusedcontents should not be reinfused
  25. 25. ComplicationsComplications  Air and fat embolismAir and fat embolism  Pulmonary dysfn. Due to infusion of debrisPulmonary dysfn. Due to infusion of debris  CoagulopathyCoagulopathy  Renal dysfn.Renal dysfn.  Dissemination of malignant cellsDissemination of malignant cells
  26. 26. Clinical usesClinical uses  When it is anticipated that blood will shed into aWhen it is anticipated that blood will shed into a clean wound from which can aspirated withoutclean wound from which can aspirated without HemolysisHemolysis  Used inUsed in  CardiacCardiac  VascularVascular  OrthopaedicOrthopaedic  TraumasurgeryTraumasurgery  Liver transplantationLiver transplantation
  27. 27. Post Operative Blood DonationPost Operative Blood Donation  Postoperative Blood salvagePostoperative Blood salvage: Blood is: Blood is collected after the surgical procedure iscollected after the surgical procedure is complete by drainage of the operativecomplete by drainage of the operative area and re-infused.area and re-infused. Postoperative blood salvage is usedPostoperative blood salvage is used most frequently for cardiac and orthopedicmost frequently for cardiac and orthopedic
  28. 28. Cardiac surgeryCardiac surgery Reinfusion done without washing of salvagedReinfusion done without washing of salvaged blood obtained from mediastinal drainageblood obtained from mediastinal drainage after cardiac surgery.after cardiac surgery. Safe and effective.Safe and effective. reinfusion of unwashed blood may affectreinfusion of unwashed blood may affect laboratory tests. the blood may containlaboratory tests. the blood may contain cardiac enzymes, such as creatine kinase, socardiac enzymes, such as creatine kinase, so its reinfusion may complicate the diagnosis ofits reinfusion may complicate the diagnosis of perioperative myocardial infarction.perioperative myocardial infarction.
  29. 29. Orthopedic surgeryOrthopedic surgery  Blood salvaged and reinfused afterBlood salvaged and reinfused after orthopedic surgery (e.g., hiporthopedic surgery (e.g., hip arthroplasty and spinal fusion witharthroplasty and spinal fusion with instrumentation) may be safe andinstrumentation) may be safe and reduce the amount of allogeneic bloodreduce the amount of allogeneic blood given.given.  Blood from mediastinal and chest drainBlood from mediastinal and chest drain does not require anticoagulationdoes not require anticoagulation because it is defibrinogenated.because it is defibrinogenated.
  30. 30. TRAUMATIC HEMOTHORAXTRAUMATIC HEMOTHORAX  Blood that collects in the thoracicBlood that collects in the thoracic cavity following blunt or penetratingcavity following blunt or penetrating trauma is analogous to blood shedtrauma is analogous to blood shed following cardiac or orthopedicfollowing cardiac or orthopedic surgery. It is defibrinogenated andsurgery. It is defibrinogenated and may be collected and transfused.may be collected and transfused.
  31. 31. ComplicationsComplications  Febrile reactions (6-12 hrs after operation)Febrile reactions (6-12 hrs after operation)  HypotensionHypotension  Upper airway oedemaUpper airway oedema
  32. 32. Post operative blood donationPost operative blood donation - Collected from drains but is rarely used- Collected from drains but is rarely used - To be used within 6 hrs – if not discarded- To be used within 6 hrs – if not discarded - blood collected is diluted , partially- blood collected is diluted , partially hemolysed but rich in interleukinshemolysed but rich in interleukins
  33. 33. !!!! NOTE: Always autologous blood should be trans before any allogenic blood