الله الرحمن بسمالرحيم

Ahmad Shihada Silmi,Msc, FIBMSLecturer of Haematology & Immunology

Faculty of Science, IUG

Autologous Blood BY

Autologous Blood

• Definition: An autologous donor is one who is donating blood for

his or her own use.

Types of Autologous Transfusion

• Pre operative donation.

• Acute normo-volumic hemodilution.

• Intra-operative salvage.

• Post operative salvage.

Autologous BloodAutologous 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.

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%

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.

Advantages

1 Prevent transfusion TTDs2 Prevent red cell allo-immunization3 Supplements the blood supply in BTS4 Provide soln. to patients with allo-

antibodies5 Prevent adverse transfusion reactions6 Provide soln. to religious belief

(Jehovah's witness)

Disadvantages

1- Same risk of bacterial contamination2- 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

Autologous Blood Donation

Advantages Disadvantages1. 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 supply 3. 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

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

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.

Preoperative Autologous Blood

• Transmissible Disease Testing (HIV, HCV, HBV, etc.)– NOT required unless it is to be used for

allogeneic transfusions

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”.

Autologous Sticker

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.

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?

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.

Pre-op Autologous Donation (3)

Contraindications:1 Evidence of infection and risk of bacteremia2 Scheduled surgery to correct aortic stenosis3 Unstable angina4 Active seizure disorder5 Myocardial infarction or CV accidents6 Significant cardiac or pulmonary disease7 Cyanotic heart disease8 Uncontrolled hypertension9 Malignant diseases

How to collect Autologous Blood