1. Intra operative blood conservation

2. Intra operative blood conservation

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Intra operative blood conservation
Cell processor
Method
Intra operative blood conservation

10. Intra operative blood conservation
Cell processor
Method
Intra operative blood conservation

11. 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

12. 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 micron range.
Between 1:5 and 1:10 ratio of anticoagulant to collected blood.
Intra operative blood conservation

13. 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

14. 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

15. 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

16. 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

17. 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

18. Intra operative blood conservation
CELL SAVER DEVICES
Intra operative blood conservation

19. 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

20. 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

21. 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

22. 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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