بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. Autologous Blood Transfusion

3. Autologous Blood • Definition: An autologous donor is one who is donating blood for his or her own use.

4. Types of Autologous Transfusion Pre operative donation. Acute normo-volumic hemodilution. Intra-operative salvage. Post operative salvage.

5. Autologous Blood Autologous Transfusion Options • 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.

6. Donor Criteria • Age – No age limits exist. • Weight – No strict weight limits exist. Must adjust volume of anticoagulant for donors under 50 Kgs • Hemoglobin and hematocrit – Hemoglobin should not be less than 11.0 gm/dl and hematocrit not less than 35.3%

7. Autologous Blood • Each type of autologous transfusion has potential risks and benefits. • However,when feasible, the patient should have the option to use his or her own blood. • Patients who are to undergo a procedure that is likely to require transfusion who meet the donation criteria SHOULD be informed of the option for autologous donation/transfusion, including the risks and benefits.

8. Advantages 1 Prevent transfusion TTDs 2 Prevent red cell allo-immunization 3 Provide soln. to patients with allo-antibodies 4 Prevent adverse transfusion reactions 5 Provide soln. to religious belief

9. Disadvantages 1- Same risk of bacterial contamination 2- Costlier than allogenic blood 3- Wastage of blood, if not used. 4- Chances of unnecessary transfusion 5- Subjects patient to perioperative anemia & increase likelihood of transfusion

10. Autologous Blood Donation

11. 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

12. Preoperative Autologous Blood • Transmissible Disease Testing (HIV, HCV, HBV, etc.) • NOT required unless it is to be used for allogeneic transfusions

13. Preoperative Autologous Blood 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”.

14. Autologous Sticker

15. The Process • 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. • This is NOT usually the case, though.

16. The Process • 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. Why?

17. Donor Criteria • Frequency – Not more than every three days with 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.

18. Pre-op Autologous Donation (3) Contraindications: 1 Evidence of infection and risk of bacteremia 2 Scheduled surgery to correct aortic stenosis 3 Unstable angina 4 Active seizure disorder 5 Myocardial infarction or CV accidents 6 Significant cardiac or pulmonary disease 7 Cyanotic heart disease 8 Uncontrolled hypertension 9 Malignant diseases

19. Acute Normovolemic Hemodilution (1) Definition: It is the removal whole blood from a patient just before the surgery and transfused immediately after the surgery. It is also known as ‘preoperative hemodilution’.

20. Acute Normovolemic Hemodilution (2)Procedure • Blood collected in ordinary blood bags with 2 phlebotomies & minimum of 2 units are collected • The blood is then stored at room temp. and re-infused in operating room after major blood loss. • Carried out usually by anesthetists in consultation with surgeons.

21. How to collect Autologous Blood

22. Intra-operative Blood Collection (1) Definition: Whenever there is blood loss and collected inside the body cavity, it is transfused back to the patient.

23. Intra-operative Blood Collection (2) • Oxygen transport properties of recovered red cell are equivalent to stored allogenic red cells • Contraindicated when pro-coagulant materials are applied. • Micro aggregate filter(40 micron) are used as recovered blood contain tissue debris, blood clots, bone fragments

24. Intra-operative Blood Collection (3) • Hemolysis of red cells can occur during suctioning from surface • Indications: Blood collected in thoracic or abdominal cavity due to organ rupture or surgical procedures. • Contraindications: Malignant neoplasm, infection and contaminants in operative field. • Blood is defibrinated but it does not coagulate

25. Intra-operative Blood Collection (4) Two types of procedures are available • One is simpler canisters type in which salvaged blood is anticoagulated and aspired, using vacuum supply into a liner bag (capacity 1900ml) contained in reusable canister and integal filter • Other is more automated, based on centrifuge assisted, semi-continuous flow technology • Process result in 225 ml unit of saline suspended red cells with Hct 50-60%

26. Postoperative Blood Collection (1) • Recovery of blood from surgical drain followed by re-infusion with or without processing • Shed blood is collected into sterile container and re-infused through a micro-aggregate filter • Recovered blood is diluted, partially hemolysed and de-fibrinated and may contain high concentrate of cytokines • Upper limit on the volume(1400 ml) of unprocessed blood can re-infused

27. Postoperative Blood Collection (2) • Transfusion should be within 6 hours of initiating collection • Infusion of potentially harmful material in recovered blood, free Hb, red cell stroma, marrow, fat, toxic irrigant, tissue debris, fibrin degradation activated coagulation factors and complement