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Published on : Mar 14, 2014
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Slide 1 - Autologous Blood Donation and transfusion Dr. N. Choudhury Prathama Blood Centre, Ahmedabad Only Indian blood center accredited as per ISO:15189
Slide 2 - ppt slide no 2 content not found
Slide 3 - Contents Introduction Categories Advantages and Disadvantages Indications and contraindications Preoperative Blood collection Acute Normovolemic Hemodilution Intra and Post-operative Blood collection Initiating a new program
Slide 4 - Definition Blood collected from patient for retransfusion at later time into the same individual is called autologous blood transfusion.
Slide 5 - Types of Autologous Transfusion Pre operative donation, Acute normo-volumic hemodilution, Intra-operative salvage, Post operative salvage (Leap frog technique)
Slide 6 - Advantages 1 Prevent transfusion TTDs 2 Prevent red cell allo-immunization 3 Supplements the blood supply in BTS 4 Provide soln. to patients with allo-antibodies 5 Prevent adverse transfusion reactions 6 Provide soln. to religious belief (Jehovah's witness)
Slide 7 - Disadvantages 1 Same risk of bacterial contamination 2 Same risk of ABO incompatibility error 3 Costlier than allogenic blood 4 Wastage of blood, if not switched over. 5 Chances of unnecessary transfusion 6 Subjects patient to perioperative anemia & increase likelihood of transfusion
Slide 8 - Prathama’s Reception Area
Slide 9 - Preop. Autologous donation (1) Inclusion: Stable patients scheduled for surgical procedure in which blood transfusion is likely. Donor Pt. should qualify criteria for blood donation Necessity: a. Close liaison between clinician & blood bank (BB) b. Donor suitability by BB physician c. Oral Fe one week before & many weeks after d. Hb% should drop below 10 gm%.
Slide 10 - Pre-op. Autologous donation (2) Indications: Major Orthopedic surgeries: (Hip & Knee replacement surgeries) Cardiovascular surgeries: (Valve surgery & ? CP bypass surgery) Obstetric surgeries (hysterectomy, ovarian tumour etc.) Radical prostectomy, mastectomy, Gatro-surgery (Gall bladder, Gastectomy, OLT, splenectomy)
Slide 11 - Pre-op Autologous Donation (3) Contraindications: 1 Evidence of infection and risk of bacteremia 2 Scheduled surgery to correct aortic stenosis 3 Unstable angina 4 Active seizure disorder 5 Myocardial infarction or CV accidents 6 Significant cardiac or pulmonary disease 7 Cyanotic heart disease 8 Uncontrolled hypertension 9 Malignant diseases
Slide 12 - Each blood centre or hospital that decides to conduct an autologous blood collection program must have its own policies, processes and procedures Patient’s physician initiates the request for autologous services, which then is approved by Transfusion Medicine physician after physical evaluation Patient advised oral supplemental iron Request by physician should include the patient name, unique identifying number, number of units and kind of component required, date of scheduled surgery, nature of surgical procedure Pre-op Autologous Donation (4) Procedure
Slide 13 - Pre-op Autologous Donation (5) Procedure A sufficient number of units should be drawn to avoid exposure to allogenic blood Two units collection via an automated red cell aphaeresis system may also be an option Difference between two collections, >72 hours The last collection should be >72 hours before surgery
Slide 14 - Pre-op Autologous Donation (6) Procedure ABO and Rh typing on labeled samples of patient. Units should have ‘green label’ with patient name & number & marked ‘FOR AUTOLOGOUS USE ONLY’ Longest possible shelf life for collected units increases flexibility for the patient and allows time for restoration of red cell mass, between collection and surgery. Liquid storage is feasible for 6 weeks. For longer duration, the red have to be frozen. Special Autologous label may be used with numbering to ensure that oldest units are issued first.
Slide 15 - Autologous Sticker
Slide 16 - Acute Normovolemic Hemodilution (1) Definition: It is the removal whole blood from a patient just before the surgery and transfused immediately after the surgery. It is also known as ‘preoperative hemodilution’.
Slide 17 - Acute Normovolemic Hemodilution (2)Procedure Blood collected in ordinary blood bags with 2 phlebotomies & minimum of 2 units are collected The blood is then stored at room temp. and re-infused in operating room after major blood loss. Carried out usually by anesthetists in consultation with surgeons.
Slide 18 - Blood units are re-infused in reverse order of collection. Theme behind: Patient losses diluted blood during surgery and replaced later with autologous blood. Withdrawal of whole blood and replacement of with crystalloid/ colloid solution decreases arterial O2 content but compensatory hemo-dynamic mechanisms and existence of surplus O2 delivery capacity mechanism make ANH safe. Acute Normovolemic Hemodilution (3) Procedure
Slide 19 - Acute Normovolemic Hemodilution (4) Procedure Drop in red cell number lowers blood viscosity, decreasing peripheral resistance and increasing cardiac output. Administrative costs are minimized and there is no inventory or testing cost This also eliminates the possibility of administrative or clerical error Usually employed for procedures with an anticipated blood loss is one liter or more than 20% of blood volume.
Slide 20 - Acute Normovolemic Hemodilution (5) Procedure Decision about ANH should be based on surgical procedure, preoperative blood volume and hematocrit, target hemodilution hematocrit, physiologic variables Careful monitoring of patient’s circulating volume and perfusion status Blood must be collected in an aseptic manner Units must be properly labeled and stored
Slide 21 - Intra-operative Blood Collection (1) Definition: Whenever there is blood loss and collected inside the body cavity, it is transfused back to the patient.
Slide 22 - Intra-operative Blood Collection (2) Oxygen transport properties of recovered red cell are equivalent to stored allogenic red cells Contraindicated when pro-coagulant materials are applied. Micro aggregate filter(40 micron) are used as recovered blood contain tissue debris, blood clots, bone fragments
Slide 23 - Intra-operative Blood Collection (3) Hemolysis of red cells can occur during suctioning from surface (vacuum not more than 150 torr is recommended) Indications: Blood collected in thoracic or abdominal cavity due to organ rupture or surgical procedures. Contraindications: Malignant neoplasm, infection and contaminants in operative field. Blood is defibrinated but it does not coagulate
Slide 24 - Intra-operative Blood Collection (4) Two types of procedures are available One is simpler canisters type in which salvaged blood is anticoagulated and aspired, using vacuum supply into a liner bag (capacity 1900ml) contained in reusable canister and integal filter Other is more automated, based on centrifuge assisted, semi-continuous flow technology Process result in 225 ml unit of saline suspended red cells with Hct 50-60%
Slide 25 - Component Room
Slide 26 - Postoperative Blood Collection (1) 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 Recovered blood is diluted, partially hemolysed and de-fibrinated and may contain high concentrate of cytokines Upper limit on the volume(1400 ml) of unprocessed blood can re-infused
Slide 27 - Postoperative Blood Collection (2) Transfusion should be within 6 hours of initiating collection Infusion of potentially harmful material in recovered blood, free Hb, red cell stroma, marrow, fat, toxic irrigant, tissue debris, fibrin degradation activated coagulation factors and complement
Slide 28 - New Program (1) Defining Indications: Cardiothorasic, Vascular, Orthopedic & Obstetric Special screening and Phlebotomy: No age bar, Hb-11gm%, many variations as compared to homologous donations Scheduling: 72 hours or once a week duration; documentations Policies: Largely Whole blood No cross-over (?) No to TTD positive blood Cross-match, to avoid last minute check
Slide 29 - New Program (2) SOPs at each step Testing Protocol: Once in 30 days Separate inventory to avoid mix-ups Separate tags/ green labels to ensure that the right unit goes to right patient X-match & Issue Discarding unused unit and not used as allogenic because of different criteria and chances of clerical error