Auto Logous Transfusion

8/3/2019 Auto Logous Transfusion

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Autologous Transfusion &

Blood sparing strategies

Dr PV Sulochana

Blood Transfusion Officer Dept of Transfusion Medicine

Sree Chitra Tirunal Institute for Medical

Sciences & Technology

Thiruvananthapuram 11

1www.similima.com



History

• AT attempted by James Blundell in 1818

Highmore W in 1874

Duncan J in 1886

• Revived in 1960 by Dyer RH, Klebanoff G,Wilson D & Taswell HL.

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Decades of clinical application demonstrate

that it is quite feasible to auto transfuse blood

that has been collected and stored for an

interval up to 6 weeks in standard storage

media and 3 standard collection

volumes(approx 500ml) can be collected from

normal sized adults (50kg)-British committee

for standards in hematology,Tx

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• AT indicate that donor and recipient are

identical.

• Was very much under utilized

• Recent growth due to the emergence of HIV

•Used as part of a comprehensive strategy of

blood conservation

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Advantages

• Eliminate viral & parasitic transmission• Prevent - immune mediated reactions

-alloimmunization

-potential immune modulatory effects

• Supplement blood supply

• Reassurance for donor patient

• Source of blood for pts with multiple

alloantibodies

• Stimulate erythropoiesis

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Disadvantages

• Donor reaction

• Increased cost and complexity of

service

• Outdating of units if surgery is

postponed

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Different types

• Pre op donation-blood drawn prior to anticipated

need

•Intra op hemodilution-blood collected at the startof surgery and reinfused during/at the end of

surgery.

• Intra operative blood collection-blood recovered

from surgical bleed and reinfused

• Post operative blood salvage-shed blood from

surgical drain collected and reinfused7www.similima.com



Indication

• Patients undergoing only elective surgery.

• Type & Screen cases not to be considered.

• Consider delay in surgery,time interval

available,expected blood loss,patient’s fitness

to undergo several blood donations.

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Patient eligibility

• Should be free from cardiovascular,

cerebrovascular & respiratory diseases.

• Hb level >11g/dL & Hct 34%.

• No specific age limit.

• Must have good venous access & can

comprehend and willing to cooperate.

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Contraindications

• Unconfirmed or unreliable surgical date

• Anemia

• Poor venous access

• Active infection

• Ischaemic heart disease• Stenotic valvular disease

• Uncontrolled hypertension

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Contraindications-cont

• Respiratory disease: restrictive or obstructivelung disease

• CNS: Cerebral tumor,Epilepsy, h/o stroke or

Transient Ischaemic Attack.

• Pregnancy: impaired placental flow, IUGR,

pregnancy related hypertension, pre

eclampsia, cardiac disease, respiratory

disease, renal disease, insulin dependentdiabetes.

• Patients with virological markers

• Adverse reaction to phlebotomy11www.similima.com



General guidelines

• Written information.

• Informed consent.Explain risks & merits.

• Request from treating physician in writing

should be kept by the collecting facility.

• Request include name, number, number of

units, kind of component, anticipated surgical

date & surgical procedure.12www.similima.com



Donation schedule

• Governed by operation date & shelf life of

blood.

• Once enrolled give oral iron supplemtn.

• Weekly schedule is used

• Last donation occurs 72 hrs prior to surgery.

• Check Hb before each collection.

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Pre donation check by

phlebotomist• Donor’s identity checked

• Health history.donor should not bethirsty or hungry.

• Temperature.

• Pulse.

• Hb.

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Volume collected

• Patients weighing >50 kg,collect standard unit

• <50kg proportional reduction in volume.

• Volume should not exceed 15% of donors

blood volume.

• Skin preparation-surgical cleanliness for

maximum product safety.

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Lab testing

• ABO & Rh group

• Testing for TTD?

• Culture for asymptomatic bacteremia.

• Compatibility?

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Labeling

• Label should contain “For autologous

use only, not suitable for other patients”

• Special label in addition to blood group

and product, patient ID.

• Date of collection.

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Storage

• Physically separated from homologous

blood stock.

• Store at 4-60C.

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Records

• All consent forms, donation records and

transfusion records must be handled as

for homologous transfusion.

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Acute normovolemic hemodilution

• Patients who are not anemic can have

about one quarter of their blood volume

withdrawn (not exceeding 20ml/kg)

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ANH is simpler,less expensive and

available to patients undergoing surgery

at short notice.

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Indication

Patients who can tolerate rapid

withdrawal of one or several units of

blood (not exceeding 20ml/kg) before

the period of blood loss

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Benefits

• Lowering blood viscosity improves tissue

perfusion and oxygenation.

• Reduce red cell loss at intraoperativehemorrhage.

• Provide fresh whole blood with coagulation

factors and functional platelets.• Reduce the need for allogenic blood, there by

avoiding TTD.& immune mediated reactions.

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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 andcerebrovascular diseases.

• Hb level >11g/dl

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Exclusion criteria

• Hb<11g/dl

• IHD, critical stenotic heart valve disease,

symptomatic AS

• Uncontrolled HT(BP >180/100) or

hypotension. Patient on ß blockers/calciumchannel blockers.

• Restrictive/obstructive lung disease25www.similima.com



Exclusion criteria-cont

• Impaired renal function

• Coagulation disorders.

• Potential or active bacterial infection.

• Hypovolaemia.

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Consent: Should obtain valid consent

Protection against contamination

Blood should be withdrawn through

arterial/venous catheter

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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 28www.similima.com



Volume replacement

• Crystalloid/ colloid should be given

simultaneously as blood is withdrawn.

• Monitoring –continuous monitoring of

hemodynamic variables

29www.similima.com



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 2-60C.30www.similima.com



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.

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Intra operative blood collection

• Collection & return of blood recovered from

operative sites or from associated extra

corporeal blood circuits.

• Technique has been widely used in cardiac,

vascular and orthopedic surgery.

• In addition to decreasing allogenic donor

exposure, IBC provide an important source of

red cell mass during massive transfusion.32www.similima.com



Indication

Most suitable in anticipated blood loss >20%

Conditions-surgical field free of tumor cells,

sterile & with out hemolysis.

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Contraindications

• Malignancy.

• Infection.

• Contamination –hemolysis,

procoagulants, FDP, fat particles,

amniotic fluid.

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Postoperative Blood Collection

• Collection of blood from surgical drains and

reinfusion with or without processing.

• Used after cardiac & orthopedic surgeries.

• Shed blood collected and reinfused through

microaggregate filter.

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Other blood sparing strategies

• Iron supplementation.

• Improve surgical procedures.

• Blood auditing.

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Pharmacological alternatives

• Recombinant growth factors:

- Erythropoietin.

- GM -CSF, G-CSF.

- Red Cell substitutes.

- DDAVP.- Vit K.

- Fibrinolytic inhibitors.37www.similima.com



References

• Technichal Manual AABB

• The Hongkong Association of Blood Transfusion

and Hematology.

• Autologous and Directed Blood Programs-AABB

• British Committee for Standards in

Haematology,Transfusion-Guidelines for

alternatives to allogenic transfusion

38www.similima.com



Thank you39www.similima.com

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