Autologous Blood Transfusion

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Autologous Blood Transfusion

• Collection and re-infusion (transfusion) of the
  patients own Blood or Blood components.

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AutologousBlood Transfusion

• Pre-surgical Autologous Blood Donation
• Normovolemic Haemodilution
• Intraoperative Cell Saver
• Postoperative Blood Salvage

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Why Autologous 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 dependant on the blood banks stock.

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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
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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.

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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.

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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.

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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

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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

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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 bacteraemia at time of donation
• No h/o hepatitis B/C or HIV
• Cancer not a contraindication

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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

Goodnough et al Transfusion 199232441-445
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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.

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Autologous Blood Donation During Pregnancy

• Indications high risk of bleeding (eg placenta
  praevia), alloimmunisation.
• Contraindication impaired placental flow, IUGR.
• Labour ward with continuous CTG monitoring.
• Potential risks of
• premature labour
• fetal complications in impaired placental flow
• may not be able to avoid allogeneic blood.

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Singapore Programme

• Started since 1987
• Bloods are either collected at the Centre for
  Transfusion Medicine (private/smaller hospitals)
  or at autologous clinics in the hospitals (TTSH,
  KKH). Teaching hospitals collect their own
  autologous blood
• Cases maxilo-facial, orthopaedics, obs/gynae,
  general surgery, urology

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Autologous Collection in the past 5 yrs
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High-risk Autologous Clinic

• Pilot project with Dept. of Anaesthesia and Dept.
  of Haematology, SGH
• For older patients (lt75 years)
• For patients with IHD
• For patients with h/o epilepsy

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AutologousBlood Transfusion

• Pre-surgical Autologous Blood Donation
• Normovolemic Haemodilution
• Intraoperative Cell Saver
• Postoperative Blood Salvage

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Points to consider

• Cost
• Surgeon and Anaesthetist enthusiasm
• Availability of allogeneic blood
• Which types of procedures cardiac clean
  operations
• Public awareness

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CENTRE FOR TRANFUSION MEDICINE
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