1. Benefits of autotransfusion
Overview of applications & indications
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2. Content Allogeneic Transfusions - Potential Risks
Quality of Stored blood
Washed versus unwashed blood
Hematocrit of different Blood Products
Applications for Autotransfusion
Indications for Autotransfusion
Contraindications for Autotransfusion
Intraoperative Autotransfusion - Benefits

3. Allogeneic Transfusions - Potential Risks
Viral infection
Bacterial infection
Transfusion reactions
Immune suppression

4. Quality of Stored blood
Stored cells breakdown over time and the breakdown begins within hours of collection.
Stored RBC biochemical defects which are called collectively the “storage lesion.”
These changes include decreased 2,3-DPG and ADP and ATP, poor deformability. Deformability is important for normal RBC function.
Cytokines are released from white blood cells and free hemoglobin and potassium leak from the cells.
This results in poorer performance at the tissue level, where it matters most.
Oxygen is not released as well in stored RBC compared to fresh RBC. Investigators have found that oxygen extraction is 54% worse in stored RBC.
Source: Tsai et al. Transfusion 2004;44:

5. Washed versus unwashed blood
Relative risk of exposure to allogeneic RBC
Washed: 54% transfused
Unwashed: 73% transfused
Washed RBCs are high quality (measured by post-transfusion survival)
Unwashed blood
Lower Hct
Platelets present, but function may be impaired
Anticoagulant present in measurable amounts
Coagulation components could cause coagulation abnormalities
In a meta analysis involving 19 studies comparing washed versus unwashed RBC in a variety of surgical applications, patients who received unwashed RBC were much more likely (73% vs 54%) to be transfused with allogeneic blood.
Source: The Cochrane Library 2006, Issue 1

6. Hematocrit of Different Blood Products
There are significant differences in the hematacrit of RBC being reinfused to the patient, depending on the type of autotransfusion system used.
In unwashed RBC systems (“flip and drip”) the hematacrit is around 30%.
In banked, allogeneic blood, the hematacrit is 50 – 60%.
With the OrthoPat system, the RBC’s are washed and concentrated, resulting in a product with a 70 – 80% hematacrit.
Unwashed
Autotransfusion
~30% Hematocrit
Banked
Blood
50%–60% Hematocrit
OrthoPAT
Blood Product
Up to 70% Hematocrit

7. Applications for Autotransfusion
Widely applied technology
Used for high blood loss surgeries
aortic aneurism
Used for elective surgeries with medium blood loss
orthopedic surgeries
cardiac surgeries
Obstetric surgeries
caesarean section with high risk factors for hemorrhage – amniotic fluid needs to be removed and leucodepletion filter use is recommended
Acceptable by patients with specific religious beliefs

8. Indications for Autotransfusion
Anticipated blood loss (adult) ≥ 20% of estimated blood volume
Anticipated blood loss (child) ≥ 15% of estimated blood volume
Undergoing procedure for which blood is routinely cross-matched
Procedure for which more than 20% of patients are transfused

9. Indications for Autotransfusion (cont.)
Mean transfusion volume exceeds one unit
The patient has alloantibodies
The patient has a low hematocrit and/or no predeposit units of blood
Compatible allogeneic blood is not available.

10. Contraindications for Autotransfusion
Physician must determine risk/benefit factor
Autotransfusion with cancer surgery is normally contraindicated
Contamination of the surgical site e.g. abdominal procedure pose the risk of contamination of shed blood
Presence of amniotic fluid is a potential contamination: removal of amniotic fluid and use of leucodepletion filter are recommended
Every decision is under the responsibility of the
physician(s) treating the patient.

11. Intraoperative Autotransfusion - Benefits
Reduces need for allogeneic blood by 40-60%
Prevents transfusion- transmitted disease
Prevents red cell alloimmunization
Higher O2 delivery capacity
Washed RBC reduces exposure to activated clotting factors, biologic modifiers, surgical debris
Improved tissue perfusion
Source: Yomtovian R. In Transfusion Reactions 2001, Tsai A. Transfusion 2004;44:1626

12. Intraoperative Autotransfusion – Benefits (cont.)
Autotransfusion & Length of Stay (LOS) Scott et al.
Cardiac surgery, CABG
N=1746
Prospective, randomized, controlled trial
Allogeneic transfusion vs. not transfused
Reduced LOS by 2.9 days
Transfused Not transfused
7.2 days days
p  0.001
In a prospective, randomized controlled study of patients undergoing cardiac surgery, patients that did not receive a transfusion had a shorter length of stay than those receiving a transfusion.
Suggested Slide Use: Slide should be used in the General and Clinical presentations
Source: Scott et al. American Society of Anesthesiologists Abstract 2006

13. Intraoperative Autotransfusion – Benefits (cont.)
Autotransfusion & Length of Stay (LOS) Innerhofer et al.
Prospective, observational study
N=385
Elective orthopedic surgery (primary/revision hip replacement, spinal surgery)
Recipients of autologous blood:
0.8 day less LOS
In this prospective study the rate of complications and length of stay were evaluated in elective orthopedic surgery (THA/TKA/spines) patients receiving autologous blood, allogeneic blood or no transfusions. Infectious complications were fewer and length of stay shorter (about 1 day) in the recipients of autologous blood compared with recipients of allogeneic blood.
Suggested Slide Use: Slide should be used the General and Clinical presentations (if interested in orthopedic solution)
Source: Innerhofer et al. Transfusion 1999;39:

14. Intraoperative Autotransfusion – Benefits (cont.)
OrthoPAT® System reduced the need for allogeneic
transfusions
Procedure
Allogeneic Transfusion Risk Reduction P
Primary/revision hip
2.7-fold
 .05
Primary/revision Knee
2.3-fold
This study looked at primary hip and knee surgery in patients utilizing the OrthoPAT but not PAD, compared to patients not using blood salvage technology.
OrthoPAT reduced the need for allogeneic blood 2.3 – 2.7 fold, a statistically significant difference.
Clark et al
N = 398; 5 hip or knee cohorts
OrthoPAT used, without preoperative autologous blood donation
Source: J Arthroplasty 2006;21:23-35 14

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