Intra operative blood conservation

Intra operative blood conservation

Intra operative blood conservation Advantages of autologous blood AUTOLOGUS BLOOD TRANFUSION Prevents transfusion-transmitted disease Prevents red cell alloimmunization Supplements the blood supply Provides compatible blood for patients with alloantibodies Prevents some adverse transfusion reactions Provides reassurance to patients concerned about blood risks Intra operative blood conservation

Intra operative blood conservation Comparison AUTOLOGUS BLOOD TRANFUSION 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 Intra operative blood conservation

Intra operative blood conservation Autologus Transfusion PAD/SFDN-Pre op autologus donation. ANH-Acute normovolumic hemodilution ICS-Intra operative cell salvage AUTOLOGUS BLOOD TRANFUSION TYPES Intra operative blood conservation

Intra operative blood conservation ICS Intra op cell salvage Intra operative cell salvage The technique of collecting and reinfusing blood lost by a patient during surgery. Intra operative blood conservation

Intra operative blood conservation HISTORY 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 ICS Intra op cell salvage Intra operative blood conservation

Intra operative blood conservation Blood salvage procedures TYPES 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 Intra operative blood conservation

Intra operative blood conservation Cell processor Method Intra operative blood conservation

Intra operative blood conservation Cell processor Method Intra operative blood conservation

Intra operative blood conservation Method 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. Intra operative blood conservation

Intra operative blood conservation Method 2.STORAGE 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. Intra operative blood conservation

Intra operative blood conservation Method 3.CENTRIFUGE 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 Intra operative blood conservation

Intra operative blood conservation Method 4.washing 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. Intra operative blood conservation

Intra operative blood conservation Method 5.Waste separation Waste products include white blood cells, platelets, plasma, anticoagulant, fat and free plasma haemoglobin. These are collected in a bag. Intra operative blood conservation

Intra operative blood conservation Method 6.Processed RBC Packed red blood cells are separated from waste products and collected in a separate bag Intra operative blood conservation

Intra operative blood conservation Method 7.Reinfusion 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. Intra operative blood conservation

Intra operative blood conservation CELL SAVER DEVICES Intra operative blood conservation

Intra operative blood conservation 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. Practical considerations Intra operative blood conservation

Intra operative blood conservation Ultrafiltration Ultrafiltration of Whole Blood 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. Intra operative blood conservation

Intra operative blood conservation Ultrafiltration Ultrafiltration of Whole Blood 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 Intra operative blood conservation

Intra operative blood conservation Direct transfusion DIRECT TRANFUSION 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 Intra operative blood conservation

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