1. AUTO TRANSFUSIONAUTO TRANSFUSION
Dr. Lokesh SharoffDr. Lokesh Sharoff

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. 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. 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.  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.

6. DISADVANTAGESDISADVANTAGES
-PERIOPERATIVE ANEMIA-PERIOPERATIVE ANEMIA
-COSTLIER-COSTLIER
-CLERICAL ERROR-CLERICAL ERROR
-UNNECESSARY WASTAGE OF BLOOD-UNNECESSARY WASTAGE OF BLOOD
-RISK OF BACTERIAL CONTAMINATION-RISK OF BACTERIAL CONTAMINATION
-INCREASED COMPLEXITY OF-INCREASED COMPLEXITY OF
PROCEDUREPROCEDURE

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. 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.  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. 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.  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. 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. 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. 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. 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.  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 blood.surgery is diluted blood.

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. 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. 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. 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.  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. ComplicationsComplications
 Myocardial ischaemiaMyocardial ischaemia
 Cerebral HypoxiaCerebral Hypoxia
 CoagulopathyCoagulopathy
 Peripheral OedemaPeripheral Oedema

23. Intraoperative blood donationIntraoperative blood donation
 It is recovery or salvage of blood shed inIt is recovery or salvage of blood shed in
surgery.surgery.
 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.  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. 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. 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

28. 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
surgery.surgery.

29. 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.

30. 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.

31. 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.

32. ComplicationsComplications
 Febrile reactions (6-12 hrs after operation)Febrile reactions (6-12 hrs after operation)
 HypotensionHypotension
 Upper airway oedemaUpper airway oedema

33. 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

34. !!!!
NOTE: Always autologous blood should be
trans before any allogenic blood