Autotransfusion

Autotransfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously 'pre-donated' (termed so despite 'donation' not typically referring to giving to one's self) before a surgery, or alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device (such as a Cell Saver or CATS). The latter form of autotransfusion is utilized in surgeries where there is expected a large volume blood loss – e.g. aneurysm, total joint replacement, and spinal surgeries. Autotransfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously 'pre-donated' (termed so despite 'donation' not typically referring to giving to one's self) before a surgery, or alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device (such as a Cell Saver or CATS). The latter form of autotransfusion is utilized in surgeries where there is expected a large volume blood loss – e.g. aneurysm, total joint replacement, and spinal surgeries. The first documented use of 'self-donated' blood was in 1818, and interest in the practice continued until the Second World War, at which point blood supply became less of an issue due to the increased number of blood donors. Later, interest in the procedure returned with concerns about allogenic (separate-donor) transfusions. Autotransfusion is used in a number of orthopedic, trauma, and cardiac cases, amongst others. Where appropriate, it carries certain advantages –including the reduction of infection risk, and the provision of more functional cells not subjected to the significant storage durations common among banked allogenic (separate-donor) blood products. Autotransfusion also refers to the natural process, where (during fetal delivery) the uterus naturally contracts, shunting blood back into the maternal circulation. This is important in pregnancy, because the uterus (at the later stages of fetal developtment) can hold as much as 16% of the mother's blood supply Autotransfusion is intended for use in situations characterized by the loss of one or more units of blood and may be particularly advantageous for use in cases involving rare blood groups, risk of infectious disease transmission, restricted homologous blood supply or other medical situations for which the use of homologous blood is contraindicated. Autotransfusion is commonly used intraoperatively and postoperatively. Intraoperative autotransfusion refers to recovery of blood lost during surgery or the concentration of fluid in an extracorporeal circuit. Postoperative autotransfusion refers to the recovery of blood in the extracorporeal circuit at the end of surgery or from aspirated drainage. The disadvantage of autotransfusion is the depletion of plasma and platelets. The washed autotransfusion system removes the plasma and platelets to eliminate activated clotting factors and activated platelets which would cause coagulopathy if they were reinfused to the patient, generating a packed red blood cell (PRBC) product. This disadvantage is only evident when very large blood losses occur. The autotransfusionist monitors blood loss and will recommend the transfusion of fresh frozen plasma (FFP) and platelets when the blood loss and return of autotransfusion blood increase. Typically the patient will require FFP and platelets as the estimated blood loss exceeds half of the patient's blood volume. When possible diagnostic tests should be performed to determine the need for any blood products (i.e. PRBC, FFP and platelets). The use of blood recovered from the operative field is contraindicated in the presence of bacterial contamination or malignancy. The use of autotransfusion in the presence of such contamination may result in the dissemination of pathologic microorganisms or malignant cells. The following statements reflect current clinical concerns involving autotransfusion contraindications. Any abdominal procedure poses the risk of enteric contamination of shed blood. The surgical team must be diligent in observing for signs of bowel contamination of the blood. If there is a question of possible contamination the blood may be held until the surgeon determines whether or not bowel contents are in the surgical field. If the blood is contaminated the entire contents should be discarded. If the patient's life depends upon this blood supply it may be reinfused with the surgeon's consent. While washing with large amounts of a sodium chloride solution will reduce the bacterial contamination of the blood, it will not be totally eliminated. There is a possibility of the reinfusion of cancer cells from the surgical site. There are possible exceptions to this contraindication: