Autologous - Oma

Click to edit Master title style
AUTOLOGOUS
TRANSFUSION
Dr Om Prakash
Jr Resident
Dept of IHBT
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TOPICS
Click TO
to edit BE DISCUSSED
Master title style
INTRODUCTION
TYPES
ADVANTAGES
DISADVANTAGES
RECENT ADVANCES
SUMMARY
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INTRODUCTION
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• Blood collected from a patient for re-transfusion at a
later time into the same individual is called “Autologous
Blood".
• Donating for one’s own use.
• The patient gets the safest possible blood because no

foreign antigens infused, no infectious diseases other
than the patient may already have are transmitted.
• Its use has increased with the awareness of infections

particularly human immuno-deficiency virus transmitted
through homologous transfusion 4 4
• The appearance of the Human Immunodeficiency

virus (HIV) as a transfusion-transmissible
complication of allogeneic transfusion fostered
interest in autologous blood techniques.
• As the risk of transfusion decreased and

understanding of the risks and costs of autologous
donation increased, there has been a decline in the
utilization of preoperative blood donation.
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ADVANTAGES :
• Prevents the possibility of TTI like HIV, HBsAg, HCV and syphilis.
• Prevents alloimmunization to red cells, leukocytes, platelets , and

plasma proteins.
• Prevents adverse transfusion reactions especially allergic and febrile

reactions.
• Provides blood to patients who refuse homologous blood transfusion

because of religious belief.
• Preoperative autologous donation stimulates the bone marrow to

increase cells production.
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DISADVANTAGES:
• Subjects to patient to anemia and hypo-volemia.
• Consequences of the clerical error.
• Careful management of labelling, storage and

reinfusion is necessary.
• Inconvenient to patient-donor.
• Unnecessary loss of blood if operation is postponed

or transfusion is not needed.
• More costly than allogenic blood.

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• Risk of adverse reactions.

TYPES OF
AUTOLOGOUS
TRANSFUSION
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• Preoperative donation of blood(PAD).
• Intra-operative blood collection :
a) Perioperative Haemo-dilution (ANVHD).

b) Intraoperative (Salvage)
• Post operative blood collection.
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PRE-OPERATIVE
AUTOLOGOUS
DONATION
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Click to edit
PRE-OP: (PAD)Master title style
• Most feasible for patients surgery scheduled to take place with
in 35 - 42 days
• Long time storage in frozen state is expensive and ineffective.
• Each patient must be carefully evaluated physician and the

blood bank consultant.
• Autologous donation requires the written advice of patient's

physician required to sign a consent acknowledgement.
• A label stating "For Autologous Use Only" must be placed on

the bag.
• Autologous blood units should be stored in a separate shelf of

the blood bank refrigerator.
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INDICATIONS:
• Elective surgical procedures with sufficient time to

obtain one or more units of blood with minimum risk
and without creating significant Hb deficit in patient-
donor.
• Examples
Orthopaedic surgery (joint replacement),
Plastic and reconstructive surgery,
Cardio- vascular surgery,
Major abdominal surgery (spleenectomy),
and
Obstetrics & gynaecological conditions
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INDICATIONS:
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Eligibility of Pre-deposit:
Suitable guidelines for the individual patient-donor should be
established
• Haemoglobin:
11 g/dl or 33 per cent Hct or higher.
Below this level phlebotomy should not be done,
special circumstances with the approval of patient's
physician
but it should not be done if Hb is less than 10 g/dl.
• Age:
There is no upper or lower limit of age.
• Volume of blood withdrawn:
Donors weighing 60 kg or more can donate 450 ml of blood
but no more than 8-9 ml/kg body weight.
No more than 10% of the patients blood volume should be
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drawn at each phlebotomy.
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Click to edit
Eligibility Master title style
of Pre-deposit:
Frequency of donation:
• Scheduled weekly or even at 4 days intervals with the last
phlebotomy performed 72 hours or more before the operation.
• This allows patient-donor plasma to return to normal before
surgery.
• Oral iron (325 mg of ferrous sulfate three times a day) is given
to accelerate the restoration of Hb to pre-donation levels.
• Use of Erythropoietins along with iron is the most effective way
to enhance the chances of successful pre-donation program,
but it is expensive.
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Click to edit Master
Contraindications title
for PAD:style
• Acute localized infection
• Myocardial infarction in the past 6 months
• Unstable angina, AS, CCF ,Ventricular Arrythmias
• Marked uncontrolled hypertension
• CVA within 6 months
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Autologous Donation for Homologous use???
• A policy must be made for the PAD and allowing it to crossover for
homologous use.
• Only if it meets all standard criteria of blood donors like Hb- 12.5 g/dl and
negative for various transmissible - infections like HIV 1 &2, Hepatitis B &
C.
• However, the allogeneic use is controversial and now it is not permissible

because of donor - Patient's associated medical illness, drug intake and
other conditions.
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Click to edittests:
Laboratory Master title style
• Minimum tests for the autologous unit are ABO group and Rh typing.
• The rational for testing markers of diseases is to protect the hospital

staff rather than the intended recipient.
• Some advocate that the first unit of autologous blood should be tested
for the markers of the transfusion-transmitted diseases.
• If any infection disease test is positive, a “Biohazard Label” must be

applied to the unit(s) and the patient's physician must be informed.
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Click toOF
RECAP edit
PADMaster title style
• Most of them are done in case of Elective surgical procedures with
sufficient time .
• Each patient should be evaluated and should be informed about the

benefits and risks, consent should be obtained.
• Minimum Hb is 11g/dl, not more than 8-9ml per body weight can be
removed.
• Basic tests such as ABO and Rh typing should be done along with
screening for TTI.
• Erythropoietin and oral iron to improve blood levels before surgery.
• Autologous to homologous only if it meets all the criteria.

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INTRA-OPERATIVE
AUTOLOGOUS
DONATION
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• THEY ARE TWO TYPES
PERIOPERATIVE HEMODILUTION (AHD)
INTRAOPERATIVE BLOOD (SALVAGE)
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PERIOPERATIVE title style
HEMODILUTION:
• Acute normo volemic hemodilution(AVNHD) is the
removal of pre estimated volume of blood either
immediately before or shortly after the induction of
anaesthesia.
• Simultaneous replacement with blood volume

expanders.
• For every 1 ml of blood collected it is replaced by

Colloid (1ml)
Crystalloid (3 ml)
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• The patient's Hct is lowered to about 20% (1-3 g/dl).
• Patients of any age may be considered for ANH.
• ANH should only be considered when the potential blood loss
is likely to be greater than 20% of blood volume.
• The amount of blood withdrawn depends on the target Hct
and can be calculated using a standard formula, viz.
• V = EBV x (H o – H f)/Hav
• V = volume to be removed
• EBV = estimated blood volume (usually 70ml/kg body weight),
• Ho = initial Hct,
• Hf = desired Hct and
• Hav = average Hct (mean of Ho and Hf).
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Click–to
ANH edit Master
Patient title style
selection:
• Any patient with an adequate haemoglobin (11g/dl)
who is expected to lose >1L estimated blood volume.
• Both children & elderly can donate, the overall health

status of the patient is more important than the
chronological age.
• Patients for general, vascular, spine, orthopaedic,

obstetric & plastic surgeries are good candidates
• Jevohah’s witness patients also agree to ANH.
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ClickPHYSIOLOGY:
ANH to edit Master title style
• Drop in red cell number lowers blood

viscosity, decreasing peripheral resistance
and increasing cardiac output.
• Reduction of RBC loss.
• Increase of tissue perfusion.
• Improved oxygenation.
• Preservation of hemostasis.
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ClickADVANTAGES:
• Provides fresh whole blood for transfusion.
• No biochemical alterations associated with storage.
• Removed blood is kept in the OT, so no chance of

hypothermia
• Platelet function is preserved
• No reduction in oxygen carrying capacity
• RBC loss during surgery is less as it is diluted with

fluid
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ClickINDICATIONS:
Surgical procedures where expected loss of blood is more than

1 L.
• Cardiovascular surgery
• Vascular surgery
• Spinal surgery for scoliosis
• Total hip or knee joint replacement
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ClickCONTRAINDICATIONS:
• Anemia ,
• Hct <30%, Hb<10
• Impaired renal function
• Limitation of cardiac, pulmonary function
• Untreated hypertension
• Coagulation disorder
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ClickCOMPLICATIONS:
• Myocardial ischemia and Cerebral hypoxia

are the major potential complications,
• Fluid overload
• High blood loss procedure
• Excessive hemodilution
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Click toANH:
RECAP edit Master title style
•Removal of estimated blood volume before surgery
•Used whenever there is a potential blood loss of >1L
•Replacing it with colloids and crystalloids
•Volume of blood removal is evaluated specifically for individuals
•Red cell loss during surgery is less
•Accepted by Jehovah’s witnesses
•No biochemical alterations and no reduction in oxygen carrying

capacity
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Click toOP
INTRA edit Master title style
SALVAGE:
•Salvage –
Process of collecting shed autologous blood, processing,
and it re-administration
•Intraoperative blood salvage is the collection of shed blood from a

closed wound or body cavity during surgery and its subsequent
transfusion into the same patient
• No contamination (sepsis or penetrating wound) of surgical site or

contamination with malignant tumour cells
•Take place either in the intraoperative period or in the postop period.
•Salvage can be simply re-administered with microaggregate ﬁltration.
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Click toOP
INTRA edit Master TECHNIQUE:
SALVAGE title style
• The simplest approach — direct reinfusion without washing

—involves collection of blood under low vacuum pressure in
a plastic bag seated within a hard outer canister.
• An anticoagulant, usually citrate, is added.
• Blood salvaged from a Serosal cavity is deficient in

fibrinogen and platelets and will not clot.
• It requires no anticoagulant
• As soon as the bag is full, or within 4 hours after the start of

the collection (to prevent bacterial growth), the contents of
the bag are re-infused through a standard blood filter to the
patient
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Click to edit
INTRA-OP Master title style
SALVAGE:
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INDICATIONS title style
OF INTRA-OP:
• Cardiovascular procedures.
• Orthopaedic procedures (especially total hip

replacement and spinal surgery).
• Liver transplant.
• Ruptured ectopic pregnancy
• Trauma.
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Click to edit Master title
CONTRAINDICATIONS FORstyle
INTRA-OP:
• Infection - reinfusion of contaminated, even

washed, blood may lead to bacteremia.
• Malignancy - reinfusion of malignant cells

may lead to metastatic spread.
• Faecal contamination
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Click EFFECTS:
SIDE to edit Master title style
• Air Embolism.
• Hemolysis.
• Higher plasma free hemoglobin
• Positive bacterial culture.
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• Newer devices
Sorenson Autotransfusion Systems,
Haemonetic's Cell Saver,
that transfuse salvaged whole blood or washed red cells
have proved to be safer and no major complications
develop.
• Air embolism has never been reported with a newer

auto-transfusion device.
• The devices are costly and the process is cost effective.
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ADVANTAGES title style
& DIS-ADVANTAGES OF INTRA-OP:
• Reduction in allogeneic blood usage
• Can be used regardless of patient’s medical fitness
• Life saving where there is uncontrolled bleeding.
• System accepted by some Jehovah’s Witness
• Restricted to operations with high blood loss .

• Cannot be used where wound site has an infection.
• Not normally used where cancer cells are in the operative
field.
• Trained operators - needs sufficient suitable operations to
be cost effective.
• Only red cells are returned without platelets or plasma.
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Click to edit
POST-OP Master
BLOOD title style
SALVAGE:
• 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.
• Upper limit on the volume is 1400 ml of unprocessed

blood can re-infused.
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Click to edit BLOOD:
RECOVERED Master title style
• Diluted
• Partially hemolyzed
• High cytokines
• Free Hb
• Marrow fat
• Tissue or debris
• Fibrin degradation product
• Activated coagulation factors 45

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Click to editBLOOD:
PROCESSED Master title style
• Transfusion should be within 6hrs of initiation

of the blood collection
• Hct of processed blood is 50 – 60% and can

be varied by altering the processing
parameters.
• Processed blood has a high 2,3-DPG level.
• pH of salvaged blood is alkaline, and

potassium and sodium levels are normal
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Click to ADVANCES:
NEWER edit Master title style
A. PROTOCOL FOR THE ANH:
Leap Frog Technique
On day 0: unit A withdrawn
On day 7:
unit B & C are withdrawn and unit A is re-transfused
On day14:
unit D & E are withdrawn and unit B is re-transfused
On day 21:
unit F & G are withdrawn and unit C is re-transfued
So now unit D,E,F,G are present with us which can be

given to patient when needed
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ANH
• The units are re-infused in the reverse order

of collection, so that the first unit which has
the high Hct and most clotting factors is
administered last.
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B.AUTOLOGOUS title style
PLATELET DONATION:
• Many groups have explored the feasibility of

autologous platelet donation.
• Platelets stored in the liquid phase currently have a

shelf life of only 5 days, making autologous donation
impractical.
• However, platelets collected by apheresis and frozen

preserved in 5-6% of DMSO can be stored at −65° C
for long periods of time.
• Then thawed, washed, and re-suspended in

autologous plasma or other solutions before
transfusion.
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• They undergo a number of structural and metabolic

changes that decrease their recovery and survival, as
compared with liquid-stored platelet concentrates.
• Furthermore, most patients cannot donate sufficient

platelet units to support their need.
• It is possible to store significant numbers of frozen

autologous platelets for patients who are refractory to
platelet transfusion, provided the blood bank is technically
capable.
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Click to rinsing:
Sponge edit Master title style
• Fully soaked surgical sponges may contain 100ml of blood.
• Of this blood, approximately 95% of these erythrocytes can

be captured by rinsing the sponge in a basin of normal
saline or Ringer’s Lactate solution.
• The bloody rinse solution is then intermittently sucked into

the salvage collection reservoir at a point when the rinse
solution appears to be grossly bloody.
• This practice has been reported to increase erythrocyte

retrieval rates by 28%.
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Click to SUMMARY:
RE-CAP edit Master title style
• Autologous donations- Donating for one’s own future use
• Three types
• PAD :
DONE for Elective procedures
Informed consent should be obtained
Autologous to homologous only if criteria are met
• Intra-op:
1. A N D –
Removal of estimated volume before surgery
replacing with colloids and crystalloids
Red cell loss is less.
2. Intra-op Salvage –
Collecting the shed blood during surgery, processing and transfusing it.
Bacterial contamination is high
• Post –op:
The blood from the drains after the surgery is processed and sent back.
Collected in canister and sent back through micro-aggregate filters.
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CONCLUSION:
• Autologous donation provides the safest possible

blood to the patient
• Appropriate blood conservation techniques should

be employed
• ANH- is beneficial for providing fresh blood
• Routine use of intra & post op blood salvage is not

justified.
• Newer processing devices may improve cost-

effectiveness
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REFERENCES:
• DGHS Manual,
• Rossi’s principles of Transfusion Medicine,
• AABB manual,
• Blood banking and Transfusion Medicine , Silberstien,
• Article published in Australasian Society of Blood Transfusion.
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Thank You
55

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Click to edit Master title style

• Donating for one’s own use.

• The patient gets the safest possible blood because no

• Its use has increased with the awareness of infections

• The appearance of the Human Immunodeficiency

• As the risk of transfusion decreased and

• Prevents alloimmunization to red cells, leukocytes, platelets , and

• Prevents adverse transfusion reactions especially allergic and febrile

• Provides blood to patients who refuse homologous blood transfusion

• Preoperative autologous donation stimulates the bone marrow to

• Consequences of the clerical error.

• Careful management of labelling, storage and

• Unnecessary loss of blood if operation is postponed

• More costly than allogenic blood.

• Risk of adverse reactions.

• Preoperative donation of blood(PAD).

• Intra-operative blood collection :

a) Perioperative Haemo-dilution (ANVHD).

• Post operative blood collection.

• Long time storage in frozen state is expensive and ineffective.

• Each patient must be carefully evaluated physician and the

• Autologous donation requires the written advice of patient's

• A label stating "For Autologous Use Only" must be placed on

• Autologous blood units should be stored in a separate shelf of

• Elective surgical procedures with sufficient time to

• Acute localized infection

• Myocardial infarction in the past 6 months

• Unstable angina, AS, CCF ,Ventricular Arrythmias

• Marked uncontrolled hypertension

• CVA within 6 months

• However, the allogeneic use is controversial and now it is not permissible

• The rational for testing markers of diseases is to protect the hospital

• If any infection disease test is positive, a “Biohazard Label” must be

• Each patient should be evaluated and should be informed about the

• Erythropoietin and oral iron to improve blood levels before surgery.

• Autologous to homologous only if it meets all the criteria.

• THEY ARE TWO TYPES

PERIOPERATIVE HEMODILUTION (AHD)

INTRAOPERATIVE BLOOD (SALVAGE)

• Simultaneous replacement with blood volume

• For every 1 ml of blood collected it is replaced by

• Both children & elderly can donate, the overall health

• Patients for general, vascular, spine, orthopaedic,

• Jevohah’s witness patients also agree to ANH.

• Drop in red cell number lowers blood

• Reduction of RBC loss.

• Increase of tissue perfusion.

• Provides fresh whole blood for transfusion.

• No biochemical alterations associated with storage.

• Removed blood is kept in the OT, so no chance of

• Platelet function is preserved

• No reduction in oxygen carrying capacity

• RBC loss during surgery is less as it is diluted with

Surgical procedures where expected loss of blood is more than

• Spinal surgery for scoliosis

• Total hip or knee joint replacement

• Hct <30%, Hb<10