Autologous Transfusion

By : Jagjit Khosla

Introduction

Autologous Blood

Transfusion (ABT) means

reinfusion of blood or blood

products taken from the

same patient

Advantages of Autologous Transfusion

Advantages of ABT

Avoiding many

complications of allogenic blood transfusion

Advantages of ABT

NoAcute

hemolytic reaction

Advantages of ABT

No

Allergic or Febrile reaction

Advantages of ABT

No

Transmission of infections

Hepatitis B

AIDS

SyphilisMalaria

Advantages of ABT

Avoiding Immunosuppression by allogenic blood transfusion

Avoiding many complications of allogenic blood transfusion

Advantages of ABT

Patients with

Rare Blood groups are benefitted

Avoiding many complications of allogenic blood transfusion

Avoiding Immunosuppression by allogenic blood transfusion

Advantages of ABT

Conservation of Blood resources

Avoiding many complications of allogenic blood transfusion

Avoiding Immunosuppression by allogenic blood transfusion

Patients with Rare Blood groups are benefitted

Advantages of ABT

Avoiding many complications of allogenic blood transfusion

Avoiding Immunosuppression by allogenic blood transfusion

Patients with Rare Blood groups are benefitted

Conservation of Blood resources

Types of Autologous Blood Transfusion

Types of Autologous Transfusion

Pre – Operative Blood Donation

Acute Normo-volemic Hemodilution

Blood Salvage

Pre – Operative Blood Donation

Pre-Operative Blood Transfusion

Donating blood weeks before any Elective Surgical procedures where significant blood loss is expected which is transfused back during surgery

Person of any age

Patient should be : Weighing >50 Kg Hb > 11gm Hct > 33% Free of Infections No Cardiac Disorders 1 Unit Blood per donation

Pre-Operative Blood Transfusion

STEP 1PATIENT’S CONSENT IS TAKEN

Pre-Operative Blood Transfusion

STEP 2MEDICAL EXAMINATION &

CARDIAC EVALUATION

Pre-Operative Blood Transfusion

STEP 3COLLECTION OF BLOOD

1 Unit blood per donation

1 Donation per week

Last donation atleast 4 days before surgery

Oral Iron therapy started

Pre-Operative Blood Transfusion

STEP 4PROPER LABELLING OF BLOOD

COLLECTION PACKS FOR STORAGE

Autologous

Patient’s Name

Id number

ABO and Rh typing

Pre-Operative Blood Transfusion

STEP 5TRANSFUSING BACK THE BLOOD,

IF NEEDED, DURING SURGERY

Disadvantages of Pre-operative blood donation

Transfusion of Wrong Blood (Clerical Error)

Higher cost

Postoperative anemia

Bacterial contamination of unit

Not suitable for Emergency

Acute Normovolemic Hemodilution

Acute Normovolemic Hemodilution

“Normovolemia” means Maintaining the volume of Blood“Hemodilution” means ↓ no. of RBCs

Immediately before or after induction of anaesthesia,

1-3 units blood removed

Replace with Crystalloid or colloid

Maintains Normovolemia but leads to Hemodilution

Acute Normovolemic Hemodilution

Estimated Blood volume

Whole Blood

Whole Blood

Whole Blood

Crystalloidor Colloid

Normovolemia +

Hemodilution1-3 unit blood removed before start of surgery

Crystalloids or colloids transfused to maintain Normal volume of blood

Transfused during surgery, if needed

Advantages of Acute Normovolemic Hemodilution

No biochemical alterations associated with storage of blood

Platelet function preserved

Hemodilution → ↓Blood Viscosity → Improved Tissue Perfusion

Possible in Emergency surgeries

Less Expensive

Acute Normovolemic Hemodilution

ContraindicationsAnemiaRenal diseasesSevere CAD, severe pulmonary dysfunction

Significant Ischemic heart disease

Complications Myocardial ischemia Cerebral hypoxia

Blood Salvage

Blood Salvage

“Salvage” means saving

Blood is collected from Operative field and draining site and re-infused into the patient after processing

Specialised blood salvage machines are used

Blood Salvage

Anti- Coagulant

Collection Reservoir

Saline Wash

Operative Field

Processor

Waste

Packed RBCs

Waste include most of WBCs, Platelets, clotting factors, and cellular debris

Blood salvage

Contraindications

Gross bacterial contamination in Operative field.

Ascitic or Amniotic cavity

Free tumour tissue

Bowel contents

Blood salvage

Complications

Air embolism or Fat embolism

Hemolysis

Dilutional Coagulopathy

Blood salvage

Applications

Cardio-Vascular surgery

Liver transplantation

Neurosurgery

Ortho & Gynaecological operations