Advantages of autologous blood

Prevents transfusion-transmitted diseasePrevents red cell alloimmunization

Supplements the blood supply

Provides compatible blood for patients with alloantibodiesPrevents some adverse transfusion reactionsProvides reassurance to patients concerned about blood risks

AUTOLOGUS BLOOD

TRANFUSION

ComparisonAUTOLOGUS BLOOD TRANFUSI

ON Parameter

Autologus blood

35 (Whole Blood)

pH 7.55 6.73

Plasma hemoglobin (mg/dL)

0.5 46

Plasma potassium (mEq/L)

4.2 17.2

Plasma sodium (mEq/L)

169 153

Blood dextrose (mg/dL)

440 282

2,3-Diphosphoglycerate (µM/mL)

13.2 1

Percent survival — 79

Autologus Transfusion

•PAD/SFDN-Pre op autologus donation.

•ANH-Acute normovolumic hemodilution

•ICS-Intra operative cell salvage

AUTOLOGUS BLOOD TRANFUSI

ONTYPES

•The technique of collecting and reinfusing blood lost by a patient during surgery.

Intra operative cell salvage

ICS Intra op

cell salvage

ICS Intra op

cell salvage

•Management of severe, rapid blood loss •Reported in 1917•Started as life saving procedure than regular.•Most cases were hemothorax & turp•1970-Bently autotranfusion system•1974-Hemonetics cell saver

HISTORY

Three general types of salvage procedures:

1.Cell processors and salvage devices that wash and save red blood cells, i.e., "cell washers" or RBC-savers 2.Direct transfusion 3.Ultrafiltration of whole blood

Blood salvage proceduresTYPES

Method

Cell processor

Method

Cell processor

1.COLLECTION

•Using a dual lumen tube, anticoagulant is fed to the operation site to be mixed immediately with shed blood and sucked away.

•The choice of anticoagulant either Heparin or Citrate.

Method

•Blood and anticoagulant are carried into a sterile reservoir by vacumm.

•It is filtered to remove large clots and debris.

•Most collection reservoirs have a filter in the 40-150 micron range.

•Between 1:5 and 1:10 ratio of anticoagulant to collected blood.

2.STORAGE

Method

Blood and anticoagulant are drawn from the collection pot into a centrifuge to be processed.

The force supplied by the centrifuge holds the more dense red blood cells against the outer wall of the bowl. The less dense white blood cells, platelets, plasma and anticoagulant move towards the centre of the bowl where they spill over into a waste bag

3.CENTRIFUGEMethod

Blood is washed with a saline solution and red blood cells are separated from waste products.A sterile isotonic saline solution is pumped into the centrifuge bowl. Only a 0.9% sterile normal saline is recommended.

4.washingMethod

Waste products include white blood cells, platelets, plasma, anticoagulant, fat and free plasma haemoglobin. These are collected in a bag.

5.Waste separationMethod

Packed red blood cells are separated from waste products and collected in a separate bag

6.Processed RBC

Method

Red blood cells can then be reinfused immediately or taken to recovery or the Ward to be reinfused later. There is, however, a limit of 6 hours during which reinfusion can take place.

7.Reinfusion

Method

CELL SAVER

DEVICES

Practical consideration

s

1. If not transfused immediately, units collected from a

sterile operating field and processed with a device for intraoperative blood collection that washes with 0.9% saline, USP, shall be stored under one of the following conditions prior to initiation of transfusion:

   At room temperature for up to 4 hours after terminating collection;

   At 1–6° C for up to 24 hours, provided that storage at 1–6° C is begun within 4 hours of ending the collection.

2. Transfusion of blood collected intraoperatively by other means shall begin within 6 hours of initiating the collection

3. Each unit collected intraoperatively shall be labeled with

the patient's first name, last name, and hospital identification number; the date and time of initiation of collection and of expiration; and the statement "For Autologous Use Only."

4. If stored in the blood bank, the unit shall be handled like

any other autologous unit.

•Hemofiltration or ultrafiltration devices filter the patient's anticoagulated whole blood. •The filter process removes unwanted excess non-cellular plasma water, low molecular weight solutes, platelet inhibitors, and some particulate matter including activated cytokines, anaphylatoxins, and other waste substances through hemoconcentration; thus making concentrated whole blood available for reinfusion.• Hemofilter devices return the patient's whole blood with all the blood elements and fractions including platelets, clotting factors, and plasma proteins with a substantial Hb level.

Ultrafiltration of Whole

Blood

Ultrafiltration

Ultrafiltration of Whole

Blood

Ultrafiltration

These devices do not totally remove potentially harmful contaminants that can be washed away by most RBC-savers

That coagulation and homeostasis are immediately improved with the return of concentrated autologous whole blood

Direct transfusion is a blood salvaging method associated with cardiopulmonary bypass (CPB) circuits or other extracorporeal circuits (ECC).

Following bypass surgery the ECC circuit contains a significant volume of diluted whole blood that can be harvested in transfer bags and re-infused into patients. Residual CPB blood is fairly dilute ([Hb] = 6–9 g/dL) and can also contain potentially harmful contaminants such as activated cytokines, anaphylatoxins, and other waste substances

Direct transfusion DIRECT

TRANFUSION

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