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Autologous Blood Donation
Contents
Introduction
Categories
Advantages and Disadvantages
Indications and contraindications
Preoperative Blood col ection
Acute Normovolemic Hemodilution
Intra and Post-operative Blood col ection
Our Experience
Autologous Blood Donation
Definition
Blood collected from patient for re-transfusion
at later time into the same individual is called
autologous blood transfusion.
Why autologous donation?
Safest blood.
Shortage of blood.
As a part of blood sparing strategy.
Individuals with rare blood groups/ irregular
antibodies.
Patient's apprehensions.
Jehova's witnesses( JW).
Currently, there are more than 7.5 mil ion JW global y and around
37,913 in India, and their number is rapidly increasing.[3,4]
Advantages
Prevents transfusion-transmitted disease.
Prevents red cell allo-immunization.
Supplements the blood supply.
Prevents some adverse transfusion reactions.
Provides compatible blood for patients with
allo-antibodies.
Provides reassurance to patients concerned
about blood risks.
CONCERNS
Does NOT eliminate risk of bacterial
contamination.
Does NOT eliminate risk of ABO incompatibility
error.
May results in wastage of blood.
May subjects patients to peri-operative anemia
and increased likelihood of transfusion.
Is more costly in case of intra-operative and post
operative col ection.
Types of Autologous Transfusion
Preoperative col ection
Blood is collected and stored prior to anticipated
need.
Peri-operative col ection and administration
Acute normovolemic hemodilution: Blood is
collected at the start of surgery and then infused
during or after the procedure
Intraoperative col ection: Shed blood is recovered
from the surgical field or circulatory device then
infused.
Postoperative col ection: Blood is collected from
the drainage devices and reinfused to the patient.
Pre-operative Autologous
Donation
Blood is drawn and stored before anticipated
need.
Two or more units blood are drawn and stored
prior to anticipated need.
Should be stable patients who are scheduled
for a surgical procedure in which blood
transfusion is probable.
Indications of Pre-operative
Autologous donation
Major Orthopedic surgeries: Most common
(Hip & Knee replacement surgeries)
Cardiovascular surgeries:
(Valve surgery & ? CP bypass surgery)
Obstetric surgeries (hysterectomy, ovarian tumour
etc.)
Radical prostectomy, mastectomy
Gatro-surgery (Gall bladder, Gastectomy, OLT,
splenectomy
Contraindications / Exclusion
criteria
? Hb < 11 gm%.
? IHD, Scheduled surgery to correct aortic stenosis
? Uncontrolled hypertension ( BP > 180/100).
? Myocardial infarction or cerebrovascular accident within
6 months of donation.
? Restrictive/obstructive lung disease.
? Impaired renal function.
? Coagulation disorders, Hypovolemia.
? Active bacterial infection.
? Uncontrolled Seizure Disorder
Autologous blood should not be col ected for procedures
that seldom (less than 10% of cases) require transfusion,
such as cholecystectomy, herniorrhaphy, vaginal
hysterectomy, and uncomplicated obstetric delivery.
Pre-requisites for Pre-operative
Autologous Blood Donation.
Request from attending Physician
Written request from the Clinician is required and kept by
the col ecting facility.
Request includes :-
Patient's name,
No. of units and kind of component requested i.e. whole
blood, packed cel s etc.,
Anticipated surgical date & surgical procedure,
Clinician's comment on patient's ailment and clearance
that blood donation would not affect his physical
condition & physician's signature.
Information to the Donor
General information about blood donation and
regarding any special fee charged for the procedure
etc.
Donor Selection Criteria
Age ? No age limits exist.
Weight ? Donors weighing 60 kg or more can donate
450 ml of blood and donors weighing less than 60 kg
may donate proportionately smaller volume of blood
but no more than 8-9 ml/kg body weight.
Note: In pediatric patient of 8 years of age the weight should
be 27 kg and no more than 10% of the patients blood volume
should be drawn at each phlebotomy.
Hemoglobin and hematocrit ? Hemoglobin should
not be less than 11.0 gm/dl and hematocrit not
less than 33%.
Blood Tests:
ABO & Rh testing
Test for Transfusion Transmitted Disease
Frequency of donation:
A sufficient number of units should be drawn to
avoid exposure to al ogenic blood
Difference between two col ections, >72 hours
The last col ection should be >72 hours before
surgery
Iron Therapy
Oral iron may be prescribed to accelerate the
restoration of hemoglobin to predonation levels.
Erythropoietins along with iron can also be prescribed
to these patients but it is expensive.
Labeling of Blood Unit
Units should be clearly labeled with:-
a) Donor's name.
b) Identifying numbers, i.e. donor number.
c) Collection & Expiration date.
d) Patient's signature.
The units should be clearly marked "FOR AUTOLOGOUS USE ONLY". It
should also be labeled as Autologous Donor Blood.
A biohazard label must be applied if the donor tests positive for HCV,
HBsAg, Hepatitis B core antibodies, HIV I & II & VDRL.
In no circumstance the blood should be used for another patient (Cross
Over).
Autologous Sticker
Leap frog technique
WEEK OF
UNIT
RE INFUSION
COLLECTION
OF UNIT
1st
A
None
2nd
B
None
3rd
C
None
4th
D+E
A
5th
F+G
B
Acute Normovolemic
Hemodilution
Definition:
It is the removal whole blood from a patient
just before the surgery and transfused
immediately after the surgery. It is also known
as `preoperative hemodilution'.
Acute normovolemic hemodilution
Patients who are not anemic can have about
one quarter of their blood volume withdrawn
(not exceeding 20ml/kg)
ANH is simpler, less expensive and available to
patients undergoing surgery at short notice.
Indication
Patients who can tolerate rapid withdrawal of
one or several units of blood (not exceeding
20ml/kg) before the period of blood loss.
Benefits
Lowering blood viscosity improves tissue perfusion
and oxygenation.
Reduce red cell loss at intraoperative hemorrhage.
Provide fresh whole blood with coagulation factors
and functional platelets.
Reduce the need for allogenic blood, there by
avoiding Transfusion Transmitted Diseases & immune
mediated reactions.
Patient eligibility
Attending anesthetist should determine the
patient's suitability to undergo ANH.
Patient should have near normal O2 transport
capacity.
Free from cardiovascular, respiratory and
cerebrovascular diseases.
Hb level >11g/dl
Should obtain valid consent
Volume withdrawn
Formula to estimate the possible volume to be
withdrawn
Volume withdrawn=EBV x(Hct0-Hct1)/Hctav
EBV-estimated blood volume
Hct0-Hct before hemodilution
Hct1-desired Hct after hemodilution
Hctav- average of Hct before & after
hemodilution
Volume replacement
Crystalloid,3ml for every 1ml and colloid,1ml
for every 1ml should be given simultaneously
as blood is withdrawn.
Monitoring ?continuous monitoring of
hemodynamic variables
Labeling & Storage
With proper identification and message "For
autologous use only".
Keep the blood in the same operating room as
the patient to preserve the platelet function.
If it is anticipated that more than 6hrs will
elapse before transfusion store at 2-6 degree C.
Documentation
Written protocol describing policies &
procedure, approved by transfusion
committee.
Anaesthetist must note on the anaesthesia
record ,the amount of blood withdrawn, the
amount and type of fluid infused ,amount of
blood returned, along with patient's vital signs
Procedure
Blood collected in ordinary blood bags with 2
phlebotomies & minimum of 2 units are
collected
The blood is then stored at room temp. and re-
infused in operating room after major blood
loss.
Carried out usually by anesthetists in
consultation with surgeons
Blood units are re-infused in reverse order of
collection.
Theme behind: Patient losses diluted blood during
surgery and replaced later with autologous blood.
Withdrawal of whole blood and replacement of with
crystalloid/ colloid solution decreases arterial O2
content but compensatory hemo-dynamic
mechanisms and existence of surplus O2 delivery
capacity mechanism make ANH safe
Drop in red cell number lowers blood viscosity,
decreasing peripheral resistance and increasing
cardiac output.
Administrative costs are minimized and there is no
inventory or testing cost
This also eliminates the possibility of administrative
or clerical error
Usually employed for procedures with an anticipated
blood loss is one liter or more than 20% of blood
volume.
Decision about ANH should be based on
surgical procedure, preoperative blood volume
and hematocrit, target hemodilution
hematocrit, physiologic variables
Careful monitoring of patient's circulating
volume and perfusion status
Blood must be collected in an aseptic manner
Units must be properly labeled and stored
Intra-operative Blood Col ection
Definition:
Whenever there is blood loss and collected
inside the body cavity, it is transfused back to
the patient.
Oxygen transport properties of recovered red
cell are equivalent to stored allogenic red cells
Contraindicated when pro-coagulant materials
are applied.
Micro aggregate filter(40 micron) are used as
recovered blood contain tissue debris, blood
clots, bone fragments
Hemolysis of red cells can occur during suctioning
from surface (vacuum not more than 150 torr is
recommended)
Indications: Blood col ected in thoracic or abdominal
cavity due to organ rupture or surgical procedures.
Contraindications: Malignant neoplasm, infection and
contaminants in operative field.
Blood is defibrinated but it does not coagulate
Two types of procedures are available
One is simpler canisters type in which salvaged
blood is anticoagulated and aspired, using
vacuum supply into a liner bag (capacity 1900ml)
contained in reusable canister and integal filter
Other is more automated, based on centrifuge
assisted, semi-continuous flow technology
Process result in 225 ml unit of saline suspended
red cel s with Hct 50-60%
Postoperative Blood Col ection
Recovery of blood from surgical drain followed
by re-infusion with or without processing.
Shed blood is collected into sterile canister and
re-infused through a micro-aggregate filter.
Recovered blood is diluted, partially
hemolysed and de-fibrinated and may contain
high concentrate of cytokines
Upper limit on the volume(1400 ml) of unprocessed
blood can re-infused
Transfusion should be within 6 hours of initiating
collection.
Infusion of potentially harmful material in recovered
blood, free Hb, red cell stroma, marrow, fat, toxic
irrigant, tissue debris, fibrin degradation activated
coagulation factors and complement.
Cel Saver
Contraindications
? Malignancy
? Perforated viscera resulting in contamination
of blood with fecal matter, urine, bile etc.
? When the rate of blood loss is less than 50ml
per hour
Pharmacological alternatives
Recombinant growth factors:
- Erythropoietin.
- GM -CSF, G-CSF.
Red Cell substitutes.
Desmopressin.
Vit K.
Fibrinolytic inhibitors.
Summary
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.
SOPs at each step.
Separate inventory to avoid mix-ups.
Summary cont.
Separate tags/ green labels to ensure that
the right unit goes to right patient.
X-match & Issue.
Discarding unused unit and not used as
allogenic because of different criteria and
chances of clerical error.
References
1. Technical Manual, AABB. 18th edition.
2. R.K Saran. Transfusion Medicine Technical Manual. 2nd
Edition 2003
3. Chua R, Tham KF. Wil "no blood" kil Jehovah
Witnesses? Singapore Med J. 2006;47:994 1001.
4. Jehovah's Witness Statistics. 2013. Available from:
http://www.jwfacts.com/images/2013-publisher-
report.pdf.
Thank You
This post was last modified on 08 April 2022