Autologous blood transfusion - PowerPoint Presentation

Slide1

Autologous blood transfusion

Dr. S. Parthasarathy

MD., DA., DNB, MD (

Acu

),

Dip.

Diab

. DCA, Dip. Software statistics

PhD (

physio

)

Mahatma Gandhi medical college and research institute –

puducherry

, India

Slide2

Definition

Autologous blood transfusion is the collection of blood from a single patient and retransfusion back to the same patient when required.

Slide3

Allogenic bloodtransfusion

contrast ---- where blood from unrelated / anonymous donors is transfused to the recipientWhy?? Fear – Infection ,, resource ,,!!

Slide4

6 December 2013

4

Advantages of ABT - in short

Can

avoid many complication associated with

allogenic

transfusion

Acute hemolytic

reactions

®

Allergic & febrile

reactions

(I)

Transmission of

diseases Hepatitis

–

B,AIDS,Syphilis

, Malaria,

CJD

(I)

Slide5

RIRIR

Conservation of blood resources

®

Avoidance of immunosuppressive effects of

allogenic

transfusion

(I)

Patient’s with rare blood group are benefited

®

allows the availability of fresh whole blood for transfusion

Slide6

History

Reinfusion of blood was employed as early as 1818 & pre-operative donation was advocated in 1930s

Blood salvaging was reported during

neuro

-surgical & obstetric procedures from 1936

Fantus

in 1937 when he founded the first blood bank in the USA

During the last 20 years there is a increase in the use of ABT.

Slide7

6 December 2013

7

Techniques of ABT

3 different techniques available

Pre-operative blood donation

Acute

normo-volumic

hemo

-dilution

Intra & post-operative blood salvage

Advantages

, applications & complications vary with each technique

Slide8

Pre-operative Autologous blood donation (PABD)

Elective case

Blood loss expected

Hb

> 11 gm %

50 Kg but less

2 – 85 years

Slide9

This is also ok

Adolescents & children below 10 years also can be a candidate if cooperative

Elderly patients can safely donate.

Obstetric patients

A history of Hepatitis-B or AIDS

Slide10

contraindications

B

acteremia

A

nemia

Unstable

a

ngina,

severe

C

AD,

severe

a

ortic

stenosis

Disadvantages:

Logistic planning , wastage ,

Slide11

Conduct

Pre donation usually begins 4-5 weeks before the proposed surgery, depending on the number of units required

Usually one donation per week is done. In 5 weeks we can have 5 units of blood

Iron – oral or IV

EPO

No special complications to pre-donations

Vasovagal

reactions for which no Rx is needed This is higher is women and first time donors

Slide12

Time interval between the last donation and the surgery should be more than 72 hours

Slide13

Conduct

Separately labeled

ABO &

Rh

typing is done again

Screening for Hepatitis B and AIDS are not mandatory

No cross matching is required

If CPDA-1 is used as preservative the blood can be stored as whole blood for 35 days

Separation into plasma and RBC increases the shelf life to 42 days

If more storing is required the RBC can be frozen and stored

Slide14

Rethink

The lower preoperative

Hb

at the start of surgery increases the need for

peri

operative transfusion, which may offset some of the benefits.

Erythropoiesis

!!

Slide15

Autologous

blood should not be given merely because it is available.

The same criteria used for the transfusion of homologous blood are generally recommended when transfusing

autologous

blood

Slide16

PABT

Indications and advantages

Contraindications

Conduct

Disadvantages

Complications ??

Slide17

6 December 2013

17

Acute Normovolaemic Haemodilution

removal

of blood from the surgical patient immediately before or just after the induction of

anaesthesia

, and its replacement with

asanguinous

fluid.

No

predonation

.

donation

is done at the time of surgery, and the lost volume is replaced by crystalloids

or colloids

Slide18

Advantages

Provides fresh whole blood for transfusion.

No biochemical alterations associated with storage.

Removed blood is kept in the OR in room temperature, 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

asanguinous

fluid

Haemodilution

decreases blood viscosity , which improves tissue perfusion

Slide19

Advantages

Possible during emergency surgeries also

Patients with systemic diseases also can undergo ANH, as they are not ideal for pre donation

Can decrease the use of

allogenic

transfusions to 50 – 90 % , as we need only 1 or 2 units of blood for most of the surgeries, which is possible by ANH

ANH is simple and less expensive than pre-donation & cell savage

Slide20

Can decrease this

Slide21

Physiology

↓

in

haematocrit

,

↑ in cardiac output

↓ viscosity, ↑ venous return, improved systolic function (sympathetic drive)

Increased oxygen extraction at tissue

rightward shift of the ODC

Increased CO is due primarily to an increase in stroke volume without significant changes in heart rate.

no

hypovolemia

Slide22

Advantages

Any patient with an adequate

haemoglobin

(11gm) - expected to lose 25% of 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

,

obstretric

& plastic surgeries are good candidates

Jevohah’s

witness patients also agree to ANH

Slide23

Target hematocrit

Moderate

hemodilution

is defined as a final

Hct

between 25% and 30%; severe

hemodilution

, which is not routinely employed, is defined as a

Hct

between 10% and 20%.

Slide24

Relative contraindication

Coagulation defect

Renal failure

Severe pulmonary disease

Severe hypertension

Underlying cardiac disease

Significant

cerebrovascular

disease

Infant less than 6 months of age

Slide25

How much to take !!

patient’s current blood volume (BV),

initial

Hct

(H1)

desired

Hct

(H2)

ANH volume = BV

(H1 – H2) / HAV

ANH volume = BV

(H1 – H2) / HAV

= 5 ( 45-30) / 37.5

= 2

litres

Slide26

Blood is withdrawn from a central or peripheral vein or radial artery.

Blood is collected in standard blood bags containing CPD.

Replacement

Crystalloid 3:1

Colloids 1:1

Slide27

Conduct

Once the blood is collected, it may be kept at room temperature for up to 4–6 h. If the blood is not to be reinfused within 6 h, it should be refrigerated, used within 24 h.

CVP

IAP

First is the last!!

Slide28

Complications

Myocardial ischemia and Cerebral hypoxia are the major potential complications, but are very rare in usual circumstances.

Hct

of 15% and 25%. + LVH or CAD !!

factors that increase oxygen consumption, pain, shivering and fever, - beware !!

Slide29

‘augmented ANH’.

ANH + artificial blood

ANH + erythropoietin therapy

Slide30

ANH

Conduct

physiology

Advantages

Problems

Slide31

Intra operative blood salvage

Slide32

nineteenth century – started

Initially used in cardiac surgery, the technique is now used in over 3,50 000 cases every year during trauma, vascular, orthopedic and gynecologic surgery, as well as liver transplantation

Slide33

indications

anticipated loss of greater than 20% of the patient’s blood volume

or a surgical procedure in which more than 10% of the patients require

allogeneic

transfusions.

Slide34

Procedure

With the use of special equipments the blood is collected from the operative field and draining sites.

Recovered blood is mixed with anticoagulant is collected in a reservoir with a filter.

Micro aggregate filter(40 micron)

The filtered blood is then washed with saline. The RBCs suspended in the saline are then pumped into a re-infusion bag.

Most of the WBCs, platelets, clotting factors, cell fragments and other debris are eliminated.

Slide35

Slide36

Three types

Continuous Semi continuous devices Disposable where no washing

Slide37

Pearls

The vacuum pressure should be between 0 and 40 mm Hg.

The procedure can be carried out for up to 12 h after operation or until a maximum of 1500 ml is transfused.

Combined

intra- and postoperative cell salvage

is increasingly used for joint replacement surgery

Slide38

Can be done !!

Cochrane review of 49 randomized controlled trials over a 24-yr period showed that the use of cell salvage reduced the rate of exposure to

allogenic

blood transfusion by 40%.

It did not adversely affect mortality or complications such as bleeding, infection, myocardial infarction, thrombosis and stroke.

Slide39

Absolute contraindications

Bacterial contamination of the surgical site

Presence of amniotic fluid

Presence of local

hemostatic

agents

Cancer surgery (?)

The reinfusion of salvaged blood from an ectopic pregnancy is considered acceptable

Slide40

We used to do like this

But later abandoned it

Slide41

Cautions

complex specialized equipment

Trained personnel

The blood salvaged may contain cell debris, free

haemoglobin

and micro-aggregates.

several devices available

Slide42

Complications

Infection

Disseminated intravascular

coagulopathy

Hemolysis

- renal dysfunction

Pulmonary dysfunction

Air/fat embolism

Slide43

Routine use of intra & post op blood salvage ???

Not much useful

Slide44

Thank you all