Download MBBS Transfusion Medicine and Blood Bank Presentations 1 Autologous Blood Donation Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Transfusion Medicine and Blood Bank 1 Autologous Blood Donation PPT-Powerpoint Presentations and lecture notes


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