CLS 2215 Principles of Immunohematology

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• Autologous Blood Transfusion

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Autologous Blood

• Definition An autologous donor is one who is
  donating blood for his or her own use.

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Types of Autologous Transfusion

• Pre operative donation.
• Acute normo-volumic hemodilution.
• Intra-operative salvage.
• Post operative salvage.

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Autologous Blood

• Autologous 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.

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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

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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.

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Advantages

• 1 Prevent transfusion TTDs
• 2 Prevent red cell allo-immunization
• 3 Provide soln. to patients with allo-antibodies
• 4 Prevent adverse transfusion reactions
• 5 Provide soln. to religious belief

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Disadvantages

• 1- Same risk of bacterial contamination
• 2- Costlier than allogenic blood
• 3- Wastage of blood, if not used.
• 4- Chances of unnecessary transfusion
• 5- Subjects patient to perioperative anemia
• increase likelihood of transfusion

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Autologous Blood Donation
Advantages Disadvantages
1. Prevents transfusion-transmitted disease 1. Does NOT affect risk of bacterial contamination
2. Prevents red cell alloimmunization 2. Is more costly
3. Supplements the blood supply 3. Results in more waste
4. Provides compatible blood for patients with alloantibodies 4. Increased risk of volume overload after transfusion
5. Prevents some adverse transfusion reactions 5. Subjects patient to perioperative anemia and increase likelihood of transfusion
6. Provides reassurance to patients concerned about blood risks
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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

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Preoperative Autologous Blood

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

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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.

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Autologous Sticker
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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.

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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?

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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.

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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

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Acute Normovolemic Hemodilution (1)

• 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.

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Acute Normovolemic Hemodilution (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.

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How to collect Autologous Blood
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Intra-operative Blood Collection (1)

• Definition
• Whenever there is blood loss and
• collected inside the body cavity, it is
• transfused back to the patient.

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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

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Intra-operative Blood Collection (3)

• Hemolysis of red cells can occur during
  suctioning from surface
• 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

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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 integal filter
• Other is more automated, based on centrifuge
  assisted, semi-continuous flow technology
• Process result in 225 ml unit of saline suspended
  red cells with Hct 50-60

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Postoperative Blood Collection (1)

• Recovery of blood from surgical drain followed by
  re-infusion with or without processing
• Shed blood is collected into sterile container
  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

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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