AUTOLOGUS BLOOD

TRANSFUSION
Types of Autologous Transfusion

 Pre-surgical Autologous Blood Donation

 Normovolemic Haemodilution
 Intraoperative Cell Saver
 Postoperative Blood Salvage
Why Autologus Blood Transfusion

 Fully compatible blood.

 No risk of transfusion transmitted diseases such
as hepatitis, CMV and HIV infection.
 Avoidance of allo-immunization.
 Avoidance of GVHD.
 Improved O2 perfusion by lowering blood
viscosity.
 Acute Normovolemic Hemodilution provides fresh
whole blood .
 Less dependent on the blood banks stock.
Why Autologous Blood Transfusion

 Readily available in major haemorrhage

 Avoidance of immuno-suppression

A Clinical and Immunologic Study of Blood
Transfusion and Postoperative Bacterial
Infection in Spinal Surgery
A marked reduction in the hospital infection
rates, antibiotic usage and length of hospital
stay in patients who received autologous blood or
no blood
Triulzi et al, Transfusion 199232517-524
Pre-surgical Autologous Blood Donation

 Best choice for patients with rare blood types or

irregular antibodies. Bombay in pregnancy
 One unit per week.
 Minimum interval is 72 hours.
 Last donation must be at least 72 hrs before
operation.
 As many as 4-5 units if Hb level permits.
Labeling and Storage

 Carefully designed system.

 Special procedure code
 Autologous stamp.
 Detail of place and date of operation.
 Special and distinct label on blood pack.
 Autologous donor card with unit number on it.
 Stored in different site.
Testing of Pre-surgical Autologous Blood

 All autologous blood should be tested

 the same ways as for allogeneic blood
 Human Immunodeficiency Virus (HIV)
 Hepatitis B Virus.
 Hepatitis C Virus.
 Syphilis
 Positive units discarded.
Should Autologous Blood be made
homologous?
 The American Medical Association, AABB, NBS
discourage the crossover of unused autologous
units to the general blood supply.
 Liberal eligibility criteria.
 Safety concerns.
 Legal liability
Procedure

 The Donor Health Assessment Questionnaire to be

completed in full
 Rigid criteria for donor selection not req except
for criteria for TTD
 Criteria related to risks for TTD must continue
to be applied due to the risk of accidental
transfusion to another patient
Criteria

 Age less than 65 year old

 Hb at least 11.0g/dl
 Weight at least 25 kg
 No h/o severe heart and lung disease, abnormal
bleeding tendency
 No bacteremia at time of donation
 No h/o hepatitis B/C or HIV
 Cancer not a contraindication
Role of Erythropoietin in Autologous Donation

 Allow more units to be collected.

 Double blind trial
 I/V EPO 600 IU/kg body weight 2X/week or a
placebo.
 taking adequate iron supplement
 EPO group donated an average of 5.4 units,
placebo group, average of 4.1 units
Role of Erythropoietin in Autologous
Transfusion
 Limitation -Need two to more weeks to work.
 Expensive.
 May suppress endogenous erythropoietin up to one
week.
 May increase risk of thrombosis and hypertension.
Autologous Blood Donation During Pregnancy

 Indications high risk of bleeding (e.g. placenta Previa), Alloimmunization.

 Contraindication impaired placental flow, IUGR (Intrauterine Growth Restriction)
 Labor ward with continuous CTG monitoring.(Cardio topography)
 Potential risks of premature labor
 fetal complications in impaired placental flow
 may not be able to avoid allogeneic blood.
Points to consider

 Cost
 Surgeon and Anaesthetist enthusiasm
 Availability of allogeneic blood
 Which types of procedures :cardiac, clean
operations
 Public awareness
Autologous Blood Transfusion

 Pre-surgical Autologous Blood Donation

 Normovolemic Haemodilution
 Intraoperative Cell Saver
 Postoperative Blood Salvage
Pre Operative/pre-surgical

 Pre-operative blood donation or autologous blood donation is a coordinated donation

process planned prior to a scheduled surgical procedure, but it is not considered blood
salvage.
 If the blood is not given to the patient, it will be discarded
 Pre‐surgical autologous donation can lead to preoperative anemia which poses additional
risks for the patient.
 Each unit of blood donated decreases a person’s hemoglobin by approximately 1 g/dL.
Pre Operative/pre-surgical

 Red blood cells can be refrigerated for up to 42 days. Autologous donations may be

scheduled weekly, and optimally should be completed seven days prior to your surgery.
Intraoperative Cell Saver

 Intraoperative blood salvage, also known as cell salvage, is a specific type of autologous

blood transfusion. 
 Specifically IOS is a medical procedure involving recovering blood lost during surgery and
re-infusing it into the patient.
 It is a major form of auto transfusion. It has been used for many years and gained greater
attention over time as risks associated with allogenic blood transfusion.
  Maintenance of body temperature
 Control of pH: – The pH of blood must remain in the range 6.8 to 7.4
otherwise cells become damaged
 Removal of toxins from the body: – The kidneys filter all of the blood in the body
(approximately 8 pints), 36 times every 24 hours.
Normovolemic Haemodilution
 Acute Normovolemic Hemodilution (ANH) Also known as “isovolemic hemodilution,” this is a method
of autologous perioperative blood collection.
 In ANH, multiple units of whole blood are withdrawn from a patient immediately before a surgical
procedure, with immediate replacement of the patient’s blood volume, typically with normal saline.
 The advantages of lower costs along with no wastage of blood units. A further advantage is that since ANH
units never leave the patient's bedside, there is no possibility of an administrative error that could lead to
ABO-related hemolysis
 The idea is that the patient bleeds more dilute blood during the procedure, and the patient’s heart may pump
more efficiently due to decreased blood .
Post Operative blood salvage

 Blood salvage is performed during surgical procedures when the risk of

significant blood loss is expected. The recovered blood is collected, processed, and re-
administered to the patient, decreasing or preventing the need for allogeneic (from a
donor) blood product administration. If the blood is not given to the patient, it will be
discarded.
 At wound closure, a catheter is left in the cavity and penetrates the skin for connection to
the collection reservoir. If the blood is collected from the chest cavity, no anticoagulation is
required.