1. بسم الله الرحمن الرحيم

2. Ahmad Shihada Silmi,Msc, FIBMS Lecturer of Haematology & Immunology Faculty of Science, IUG Autologous Blood BY

3. Autologous Blood Definition: An autologous donor is one who is donating blood for his or her own use.

4. Types of Autologous Transfusion Pre operative donation. Acute normo-volumic hemodilution. Intra-operative salvage. Post operative salvage.

5. Autologous Blood Autologous Transfusion Options Preoperative collection –Blood is collected and stored prior to anticipated need. Perioperative collection and administration –Acute normovolemic hemodilution: Blood is collected at the start of surgery and then infused during or after the procedure –Intraoperative collection: Shed blood is recovered from the surgical field or circulatory device then infused. –Postoperative collection: Blood is collected from the drainage devices and reinfused to the patient.

6. Donor Criteria Age – No age limits exist. Weight – No strict weight limits exist. Must adjust volume of anticoagulant for donors under 50 Kgs Hemoglobin and hematocrit – Hemoglobin should not be less than 11.0 gm/dl and hematocrit not less than 35.3%

7. Autologous Blood Each type of autologous transfusion has potential risks and benefits. However, when feasible, the patient should have the option to use his or her own blood. Patients who are to undergo a procedure that is likely to require transfusion who meet the donation criteria SHOULD be informed of the option for autologous donation/transfusion, including the risks and benefits.

8. Advantages 1 Prevent transfusion TTDs 2 Prevent red cell allo-immunization 3 Supplements the blood supply in BTS 4 Provide soln. to patients with allo-antibodies 5 Prevent adverse transfusion reactions 6 Provide soln. to religious belief (Jehovah's witness)

9. Disadvantages 1- Same risk of bacterial contamination 2- Costlier than allogenic blood 3- Wastage of blood, if not switched over. 4- Chances of unnecessary transfusion 5- Subjects patient to perioperative anemia & increase likelihood of transfusion

10. Autologous Blood Donation AdvantagesDisadvantages 1. Prevents transfusion- transmitted disease 1. Does NOT affect risk of bacterial contamination 2. Prevents red cell alloimmunization 2. Does NOT affect risk of ABO incompatibility 3. Supplements the blood supply3. Is more costly 4. Provides compatible blood for patients with alloantibodies 4. Results in more waste 5. Prevents some adverse transfusion reactions 5. Increased risk of volume overload after transfusion 6. Provides reassurance to patients concerned about blood risks 6. Subjects patient to perioperative anemia and increase likelihood of transfusion

11. Preoperative Autologous Blood Collection Should be stable patients who are scheduled for a surgical procedure in which blood transfusion is probable. –Such as major orthopedic procedures, vascular surgery, cardiac or thoracic surgery and radical prostatectomy

12. Special Patient Categories Pediatric patients –Only with suitable volume modification (blood collected), parental cooperation and attention to preparation and reassurance Patients with significant cardiac disease are considered poor risks Serious consideration for women with alloantibodies to multiple or high incidence antigens, placenta previa, or other ante- or intrapartum hemorrhage.

13. Preoperative Autologous Blood Transmissible Disease Testing (HIV, HCV, HBV, etc.) –NOT required unless it is to be used for allogeneic transfusions

14. Preoperative Autologous Blood Blood Bag Labeling Must be labeled: “Autologous Donor” If any testing is reactive on a current collection or within the last 30 days it must also be labeled “Biohazard” Untested autologous units must be labeled “Donor Untested” If the blood tested negative within the last 30 days it must be labeled “Donor Tested Within the last 30 Days”.

15. Autologous Sticker

16. The Process Supplemental Iron –Supplemental iron should be prescribed by the requesting patients physician –Ideally prescribed before the collection of the first unit with sufficient time to allow for the patients marrow to reconstitute all or a significant portion of the donated RBC volume. –This is NOT usually the case, though.

17. The Process Collection –Request is made in writing by the requesting patients Physician –Request form is kept in the collecting facility Should include name, unique identification number, number of units, surgical procedure, and physicians signature. Schedule of Blood Collections –Depends on the number of units requested –As far ahead of the scheduled surgery as possible. Why?

18. Donor Criteria Frequency – Not more than every three days with the final donation completed at least 3 days before surgery. Medical History – Should be tailored to the needs of the donor. Such as questions about medications, associated medical illnesses and cardiovascular risk factors.

19. Pre-op Autologous Donation (3) Contraindications: 1 Evidence of infection and risk of bacteremia 2 Scheduled surgery to correct aortic stenosis 3 Unstable angina 4 Active seizure disorder 5 Myocardial infarction or CV accidents 6 Significant cardiac or pulmonary disease 7 Cyanotic heart disease 8 Uncontrolled hypertension 9 Malignant diseases

21. How to collect Autologous Blood