1. Autologous blood transfusion
Dr. S. Parthasarathy
MD., DA., DNB, MD (Acu),
Dip. Diab. DCA, Dip. Software statistics
PhD (physio)
Mahatma Gandhi medical college and research institute – puducherry, India

2. Definition
Autologous blood transfusion is the collection of blood from a single patient and retransfusion back to the same patient when required.

3. Allogenic blood transfusion
contrast ----
where blood from unrelated / anonymous donors is transfused to the recipient
Why??
Fear –
Infection ,, resource ,,!!

4. Advantages of ABT - in short
Can avoid many complication associated with allogenic transfusion
Acute hemolytic reactions ®
Allergic & febrile reactions (I)
Transmission of diseases Hepatitis – B,AIDS,Syphilis, Malaria, CJD (I)
22 February 2019

5. RIRIR Conservation of blood resources ®
Avoidance of immunosuppressive effects of allogenic transfusion (I)
Patient’s with rare blood group are benefited ®
allows the availability of fresh whole blood for transfusion

6. History
Reinfusion of blood was employed as early as 1818 & pre-operative donation was advocated in 1930s
Blood salvaging was reported during neuro-surgical & obstetric procedures from 1936
Fantus in 1937 when he founded the first blood bank in the USA
During the last 20 years there is a increase in the use of ABT.

7. Techniques of ABT 3 different techniques available
Pre-operative blood donation
Acute normo-volumic hemo-dilution
Intra & post-operative blood salvage
Advantages, applications & complications vary with each technique
22 February 2019

8. Pre-operative Autologous blood donation (PABD)
Elective case
Blood loss expected
Hb > 11 gm %
50 Kg but less
2 – 85 years

9. This is also ok
Adolescents & children below 10 years also can be a candidate if cooperative
Elderly patients can safely donate.
Obstetric patients
A history of Hepatitis-B or AIDS

10. contraindications Bacteremia Anemia Unstable angina, severe CAD,
severe aortic stenosis
Disadvantages:
Logistic planning , wastage ,

11. Conduct
Pre donation usually begins 4-5 weeks before the proposed surgery, depending on the number of units required
Usually one donation per week is done. In 5 weeks we can have 5 units of blood
Iron – oral or IV EPO
No special complications to pre-donations
Vasovagal reactions for which no Rx is needed This is higher is women and first time donors

12. Time interval between the last donation and the surgery should be more than 72 hours

13. Conduct Separately labeled ABO & Rh typing is done again
Screening for Hepatitis B and AIDS are not mandatory
No cross matching is required
If CPDA-1 is used as preservative the blood can be stored as whole blood for 35 days
Separation into plasma and RBC increases the shelf life to 42 days
If more storing is required the RBC can be frozen and stored

14. Rethink
The lower preoperative Hb at the start of surgery increases the need for peri operative transfusion, which may offset some of the benefits.
Erythropoiesis !!

15. Autologous blood should not be given merely because it is available.
The same criteria used for the transfusion of homologous blood are generally recommended when transfusing autologous blood

16. PABT Indications and advantages Contraindications Conduct
Disadvantages
Complications ??

17. Acute Normovolaemic Haemodilution
removal of blood from the surgical patient immediately before or just after the induction of anaesthesia, and its replacement with asanguinous fluid.
No predonation.
donation is done at the time of surgery, and the lost volume is replaced by crystalloids or colloids
22 February 2019

18. Advantages Provides fresh whole blood for transfusion.
No biochemical alterations associated with storage.
Removed blood is kept in the OR in room temperature, so no chance of hypothermia
Platelet function is preserved
No reduction in oxygen carrying capacity
RBC loss during surgery is less as it is diluted with asanguinous fluid
Haemodilution decreases blood viscosity , which improves tissue perfusion

19. Advantages Possible during emergency surgeries also
Patients with systemic diseases also can undergo ANH, as they are not ideal for pre donation
Can decrease the use of allogenic transfusions to 50 – 90 % , as we need only 1 or 2 units of blood for most of the surgeries, which is possible by ANH
ANH is simple and less expensive than pre-donation & cell savage

20. Can decrease this

21. Physiology ↓ in haematocrit,↑ in cardiac output
↓ viscosity, ↑ venous return, improved systolic function (sympathetic drive)
Increased oxygen extraction at tissue
rightward shift of the ODC
Increased CO is due primarily to an increase in stroke volume without significant changes in heart rate.
no hypovolemia

22. Advantages
Any patient with an adequate haemoglobin (11gm) - expected to lose 25% of estimated blood volume
Both children & elderly can donate,
the overall health status of the patient is more important than the chronological age
Patients for general, vascular, spine, orthopaedic, obstretric & plastic surgeries are good candidates
Jevohah’s witness patients also agree to ANH

23. Target hematocrit
Moderate hemodilution is defined as a final Hct between 25% and 30%; severe hemodilution, which is not routinely employed, is defined as a Hct between 10% and 20%.

24. Relative contraindication
Coagulation defect
Renal failure
Severe pulmonary disease
Severe hypertension
Underlying cardiac disease
Significant cerebrovascular disease
Infant less than 6 months of age

25. How much to take !! patient’s current blood volume (BV),
initial Hct (H1)
desired Hct (H2)
ANH volume = BV (H1 – H2) / HAV
= 5 ( 45-30) / 37.5
= 2 litres

26. Blood is withdrawn from a central or peripheral vein or radial artery.
Blood is collected in standard blood bags containing CPD.
Replacement
Crystalloid 3:1
Colloids 1:1

27. Conduct
Once the blood is collected, it may be kept at room temperature for up to 4–6 h. If the blood is not to be reinfused within 6 h, it should be refrigerated, used within 24 h.
CVP
IAP
First is the last!!

28. Complications
Myocardial ischemia and Cerebral hypoxia are the major potential complications, but are very rare in usual circumstances.
Hct of 15% and 25%. + LVH or CAD !!
factors that increase oxygen consumption, pain, shivering and fever, - beware !!

29. ‘augmented ANH’.
ANH + artificial blood
ANH + erythropoietin therapy

30. ANH
Conduct
physiology
Advantages
Problems

31. Intra operative blood salvage

32. nineteenth century – started
Initially used in cardiac surgery, the technique is now used in over 3, cases every year during trauma, vascular, orthopedic and gynecologic surgery, as well as liver transplantation

33. indications
anticipated loss of greater than 20% of the patient’s blood volume
or a surgical procedure in which more than 10% of the patients require allogeneic transfusions.

34. Procedure
With the use of special equipments the blood is collected from the operative field and draining sites.
Recovered blood is mixed with anticoagulant is collected in a reservoir with a filter. Micro aggregate filter(40 micron)
The filtered blood is then washed with saline. The RBCs suspended in the saline are then pumped into a re-infusion bag.
Most of the WBCs, platelets, clotting factors, cell fragments and other debris are eliminated.

36. Three types Continuous Semi continuous devices
Disposable where no washing

37. Pearls The vacuum pressure should be between 0 and 40 mm Hg.
The procedure can be carried out for up to 12 h after operation or until a maximum of 1500 ml is transfused.
Combined intra- and postoperative cell salvage is increasingly used for joint replacement surgery

38. Can be done !!
Cochrane review of 49 randomized controlled trials over a 24-yr period showed that the use of cell salvage reduced the rate of exposure to allogenic blood transfusion by 40%.
It did not adversely affect mortality or complications such as bleeding, infection, myocardial infarction, thrombosis and stroke.

39. Absolute contraindications
Bacterial contamination of the surgical site
Presence of amniotic fluid
Presence of local hemostatic agents
Cancer surgery (?)
The reinfusion of salvaged blood from an ectopic pregnancy is considered acceptable

40. We used to do like this
But later abandoned it

41. Cautions complex specialized equipment Trained personnel
The blood salvaged may contain cell debris, free haemoglobin and micro-aggregates.
several devices available

42. Complications Infection Disseminated intravascular coagulopathy
Hemolysis- renal dysfunction
Pulmonary dysfunction
Air/fat embolism

43. Routine use of intra & post op blood salvage ???
Not much useful

44. Thank you all