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Autologous

Blood Donation
and transfusion
Dr. J.A. Olaniyi
Depatment of Haematology
UCH, Ibadan

Contents
Introduction
Categories
Advantages and Disadvantages
Indications and contraindications
Preoperative Blood collection
Acute Normovolemic Hemodilution
Intra and Post-operative Blood
collection
New Program

Definition
Blood collected from patient for retransfusion at later time into the same
individual is called autologous blood
transfusion.
The Donor is the Recipient.
Infusion of patients own blood.

Synonyms
Autologous transfusion
Autologous blood transfusion
Autotransfusion
Auto blood transfusion
Auto hemofusion

History

Neither a new concept nor a new technology


Benefits and advantages had been known and has been in use for over 100years [ in
view of life saving effect of the procedure]
First autologous transfusions were done at the time when allogeneic transfusion was
cumbersome, if not impossible.
It was stimulated in the early years of blood banking by the involvement of patients in
donor recruitment and hence made autologous donation a convenient alternative.
Limitations then include shelf life of 7-10 days and the need for post donation
recovery time.
In the 1960s and 1970s however, its wide spread acess and use suffer a slow growing
process when public and Physicians interest diminished
It acquired inordinate importance in the 1980s after blood transfusion is realized to
be the vehicle for the for HIV 1, HTLV-1, NANB-hepatitis & other viral and
parasitic diseases
It has now become a routine measure of standard care
It is now highly desirable and recommended

Types of Autologous
Transfusion
Pre operative donation,
Acute normo-volumic hemodilution,
Intra-operative salvage,
Post operative salvage
(Leap frog technique)

Advantages
1
2
3
4

Prevent transfusion TTDs


Prevent red cell allo-immunization
Supplements the blood supply in BTS
Provide solution to patients with alloantibodies
5 Prevent adverse transfusion reactions
6 Provide solution to religious belief
(Jehovah's witness)

Disadvantages
1. Same risk of bacterial contamination
2.Same risk of ABO incompatibility error
{Clerical error}
3.Costlier than allogenic blood
4.Wastage of blood, if not switched over.
5. There are Chances of unnecessary
transfusion
6. Subjects patient to peri-operative
anemia
& increase likelihood of transfusion.

Preop. Autologous
donation (1)
Donation that sets aside patients
own blood in anticipation of
surgery so that it can be reinfused, if needed, as an
autologous transfusion during
peri-opoerative period

Preop. Autologous
donation (1)
Indicated in Stable patients scheduled for
surgical procedure in which blood transfusion
is likely.
Donor patient should meet the standard criteria
for blood donation
Necessity:
a. Close liaison between clinician & blood bank (BB)
b. Donor suitability by Blood Bank physician
c. Oral Fe one week before & many weeks after
d. Hb% should not drop below 10 gm%.

Indications POAD
POAD is indicated in anticipation of any surgical
procedure with a reasonable probability for transfusion
and for which there is sufficient time to obtain 1 U or
more with minimal risk and without creating a
significant haemoglobin deficit.
Autologous donation should be considered only if the
patient has an haemoglobin level >11g/dl.
Idealy donation interval should be one week but clearly
never less than 72hrs and never within 72hrs of the
anticipated use to allow time for volume restoration.

Pre-op. Autologous
donation (2)
Indications:
Major Orthopedic surgeries:
(Hip & Knee replacement surgeries)
Cardiovascular surgeries:
(Valve surgery & ? CP bypass surgery)
Obstetric surgeries (hysterectomy, ovarian
tumour etc.)
Radical prostectomy, mastectomy,
Gatro-surgery (Gall bladder, Gastrectomy,
OLT, splenectomy)

Study Outcome
Orthopaedic 40%
Plastic surgery
25%
Cardiovascular surgery 6%
General Surgery
5%
O&G
3%

Pre-op Autologous
Donation (3)

Contraindications:
1 Evidence of infection and risk of
bacteremia
2 Scheduled surgery to correct aortic stenosis
3 Unstable angina
4 Active seizure disorder
5 Myocardial infarction or CV accidents
6 Significant cardiac or pulmonary disease
7 Cyanotic heart disease
8 Uncontrolled hypertension
9 Malignant diseases

Pre-op Autologous
Donation (4)
Procedure
Each blood centre or hospital that decides to
conduct an autologous blood collection
program must have its own policies,
processes and procedures
Patients physician initiates the request
for autologous services, which then is
approved by Transfusion Medicine physician
after physical evaluation
Patient is placed on oral supplemental iron
Request by physician should include the
patient name, unique identifying
number, number of units and kind of
component required, date of scheduled
surgery, nature of surgical procedure

Pre-op Autologous
Donation (5)
Procedure
A sufficient number of units should be drawn
to avoid exposure to allogenic blood
Two units collection via an automated red cell
aphaeresis system may also be an option
Difference between two collections, >72 hours
The last collection should be >72 hours before
surgery.

Pre-op Autologous
Donation (6)
Procedure
ABO and Rh typing on labeled samples of patient.
Units should have green label with patient
name & number & marked FOR AUTOLOGOUS
USE ONLY
Longest possible shelf life for collected units
increases flexibility for the patient and allows
time for restoration of red cell mass, between
collection and surgery.
Liquid storage is feasible for 6 weeks. For
longer duration, the red cell have to be frozen.
Special Autologous label may be used with
numbering to ensure that oldest units are issued
first.

Acute
Normovolemic/isovolumic
Hemodilution[ANH] (1)
Definition:
It is the removal of whole blood from a
Patient and its simultaneous replacement
with an appropriate volume of acellular fluid
just before the surgery and the blood is
returned as indicated by the intra-operative
blood loss immediately after the surgery.
It is also known as preoperative
hemodilution.

ANH -Procedure
The degree of haemodilution is defined by
the final desired haematocrit
Limited Normovolumic Haemodilution:The term used for reduction of Hct to
approx 20-25%
Acute Extreme Haemodilution:- designates
reduction of Hct to <20%. Reserved for
relatively young and healthy.

ANH (2)
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.

ANH (3)
Procedure
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.

ANH (4)
Procedure
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.

ANH (5)
Procedure
Decision about ANH should be based on
surgical procedure, preoperative
blood volume and hematocrit, target
hemodilution hematocrit, physiologic
variables
Careful monitoring of patients circulating
volume and perfusion status
Blood must be collected in an aseptic
manner
Units must be properly labeled and stored

Advantages of Haemodilution
Povides the only source of fresh whole blood for
transfusion [no biochemical alterations associated
with blood storage].
Platelet function is preserved bcos of storage at
room temp.
Hypothermia associated with refrigerated blood
is avoided.
Blood is free of TTIs, haemolytic, allergic and
immunomodulatory complications of BTxn
Ever present clerical error is avoided

Advantages contd
Using the technique red cell loss is decreased.
Eg
Hct40%1000mls loss40% RBC loss
Hct 25%1000mls loss25% RBC loss
Decrease in the use of allogeneic blood to the
tune of 20-90%
Can be employed in urgent and emergency cases
Simpler and less expensive to collect 2-4 U by
haemodilution than by POAD

May represent the only alternative with


patients with potential bacteraemia from eg
indwelling catheter or ostemyelitis
Not contraindicated in the presence of
malignancy.

Intra-operative Blood
Collection (1)
Definition:
Whenever there is blood loss and
collected inside the body cavity, it
is collected and transfused back
to the patient.

Intra-operative Blood
Collection (2)
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

Intra-operative Blood
Collection (3)
Hemolysis of red cells can occur during suctioning
from surface (vacuum not more than 150 torr is
recommended)
Indications: Blood collected 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

Intra-operative Blood
Collection (4)
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 integral filter
Other is more automated, based on
centrifuge assisted, semi-continuous flow
technology. Process results in 225 ml unit of
saline suspended red cells with Hct 5060%

Postoperative Blood
Collection (1)
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

Postoperative Blood
Collection (2)
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

New Program (1)


Defining Indications: Cardiothorasic,
Vascular, Orthopedic & Obstetric
Special screening and Phlebotomy: No
age bar, Hb-11gm%, many variations as
compared to homologous donations
Scheduling: 72 hours or once a week
duration; documentations
Policies: Largely Whole blood
No cross-over (?)
No to TTD positive blood
Cross-match, to avoid last minute
check

New Program (2)


SOPs at each step
Separate inventory to avoid mix-ups
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

Conditions Excluding Autologous


Donors

Hypertension [Diastolic>100]
Hypotension [Systolic<100]
Active Asthma/pulmonary disease
History of siezures
Arrythmias/bradycardias [PR<60/min]
Major surgery [<2 months]
Tooth extraction [<72hrs]
Known AIDS

Leapfrog Technique
Starts 3 wks before surgery and could provide at
least 3U of blood, and assuming normal
erythropoiesis, only 1g/dl haemoglobin deficit
at the time of operation.
The advent of blood freezing, permitting longer
storage of blood obviated the need for leap frog
and allow development of more extensive
programme