Benefits of autotransfusion - PowerPoint Presentation

Slide1

Benefits of autotransfusion

Overview of applications & indications

© 2012 Haemonetics Corp COL-COPY-000481(AA)

Allogeneic Transfusions - Potential RisksQuality of Stored bloodWashed versus unwashed bloodHematocrit of different Blood ProductsApplications for AutotransfusionIndications for AutotransfusionContraindications for AutotransfusionIntraoperative Autotransfusion - Benefits

Content

Viral infectionBacterial infectionTransfusion reactionsImmune suppression

Allogeneic

Transfusions - Potential Risks

Quality of Stored blood

Source: Tsai et al. Transfusion 2004;44:1626-34

Relative risk of exposure to allogeneic RBC Washed: 54% transfused Unwashed: 73% transfusedWashed RBCs are high quality (measured by post-transfusion survival)Unwashed bloodLower HctPlatelets present, but function may be impairedAnticoagulant present in measurable amountsCoagulation components could cause coagulation abnormalities

Washed versus unwashed blood

Source: The Cochrane Library 2006, Issue 1

Hematocrit of Different Blood Products

Unwashed

Autotransfusion~30% Hematocrit

BankedBlood50%–60% Hematocrit

OrthoPAT

Blood Product

Up to 70% Hematocrit

Widely applied technology

Used for high blood loss surgeries aortic aneurismUsed for elective surgeries with medium blood loss orthopedic surgeriescardiac surgeriesObstetric surgeries caesarean section with high risk factors for hemorrhage – amniotic fluid needs to be removed and leucodepletion filter use is recommendedAcceptable by patients with specific religious beliefs

Applications for Autotransfusion

Anticipated blood loss (adult) ≥ 20% of estimated blood volumeAnticipated blood loss (child) ≥ 15% of estimated blood volumeUndergoing procedure for which blood is routinely cross-matchedProcedure for which more than 20% of patients are transfused

Indications for Autotransfusion

Mean transfusion volume exceeds one unitThe patient has alloantibodiesThe patient has a low hematocrit and/or no predeposit units of bloodCompatible allogeneic blood is not available.

Indications for Autotransfusion (cont.)

Physician must

determine risk/benefit factorAutotransfusion with cancer surgery is normally contraindicatedContamination of the surgical site e.g. abdominal procedure pose the risk of contamination of shed bloodPresence of amniotic fluid is a potential contamination: removal of amniotic fluid and use of leucodepletion filter are recommendedEvery decision is under the responsibility of thephysician(s) treating the patient.

Contraindications for Autotransfusion

Reduces need for allogeneic blood by 40-60%Prevents transfusion-transmitted diseasePrevents red cell alloimmunizationHigher O2 delivery capacityWashed RBC reduces exposure to activated clotting factors, biologic modifiers, surgical debrisImproved tissue perfusion

Intraoperative Autotransfusion - Benefits

Source: Yomtovian R. In Transfusion Reactions 2001, Tsai A. Transfusion 2004;44:1626

Autotransfusion & Length of Stay (LOS)

Scott et al.Cardiac surgery, CABGN=1746Prospective, randomized, controlled trialAllogeneic transfusion vs. not transfusedReduced LOS by 2.9 days Transfused Not transfused 7.2 days 4.3 days p  0.001

Intraoperative Autotransfusion – Benefits (cont.)

Source: Scott et al. American Society of Anesthesiologists Abstract 2006

Autotransfusion & Length of Stay (LOS)Innerhofer et al.Prospective, observational studyN=385Elective orthopedic surgery (primary/revision hip replacement, spinal surgery)Recipients of autologous blood: 0.8 day less LOS

Source: Innerhofer et al. Transfusion 1999;39:625-632

Intraoperative Autotransfusion – Benefits (cont.)

Intraoperative Autotransfusion – Benefits (cont.)

Clark et alN = 398; 5 hip or knee cohortsOrthoPAT used, without preoperative autologous blood donation

Source: J Arthroplasty 2006;21:23-35

OrthoPAT® System reduced the need for allogeneictransfusions

Procedure

Allogeneic

Transfusion Risk Reduction

P

Primary/revision hip

2.7-fold



.05

Primary/revision Knee

2.3-fold



.05

Thank

you

for

your

attention