Autologous Blood Transfusion by roi15698

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									               Autologous Blood Transfusion


                     Collection and re-infusion
                 (transfusion) of the patient’s own
                    Blood or Blood components.



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                               Autologous
                               Blood Transfusion




        Pre-surgical Autologous Blood
         Donation
        Normovolemic Haemodilution
        Intraoperative Cell Saver
        Postoperative Blood Salvage

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                   Why Autologous Blood Transfusion
         • Fully compatible blood.
         • No risk of transfusion transmitted diseases
           such as hepatitis, CMV and HIV infection.
         • Avoidance of allo-immunization.
         • Avoidance of GVHD.
         • Improved O2 perfusion by lowering blood
           viscosity.
         • Acute Normovolemic Hemodilution provides
           fresh whole blood .
         • Less dependant on the blood bank’s stock.

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                  Why Autologous Blood Transfusion
         •Readily available in major haemorrhage
             •Avoidance of immuno-suppression

          A Clinical and Immunologic Study of
      Blood Transfusion and Postoperative Bacterial
               Infection in Spinal Surgery
         A marked reduction in the hospital infection
         rates, antibiotic usage and length of hospital
         stay in patients who received autologous blood
         or no blood
                            Triulzi et al, Transfusion 1992;32:517-524
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                                   Pre-surgical
                            Autologous Blood Donation
      • Best choice for patients with rare blood
        types or irregular antibodies. Bombay in
        pregnancy
      • One unit per week.
      • Minimum interval is 72 hours.
      • Last donation must be at least 72 hrs
        before operation.
      • As many as 4-5 units if Hb level permits.
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       Labeling and Storage

    • Carefully designed system.
      – Special procedure code
      – Autologous stamp.
      – Detail of place and date of operation.
    • Special and distinct label on blood pack.
    • Autologous donor card with unit number on it.
    • Stored in different site.
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                            Testing of Pre-surgical
                              Autologous Blood

      All autologous blood should be tested
      the same ways as for allogeneic blood
      •Human Immunodeficiency Virus (HIV)
      •Hepatitis B Virus.
      •Hepatitis C Virus.
      •Syphilis
      •Positive units discarded.
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                   Should Autologous Blood be
                      “made homologous”?

              The American Medical Association,
              AABB, NBS discourage the
              “crossover” of unused autologous
              units to the general blood supply.
         • Liberal eligibility criteria.
         • Safety concerns.
         • Legal liability
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                            Procedure
•The Donor Health Assessment Questionnaire to
be completed in full
•Rigid criteria for donor selection not req except
for criteria for TTD
•Criteria related to risks for TTD must continue to
be applied due to the risk of accidental
transfusion to another patient


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                            Criteria

         • Age: less than 65 year old
         • Hb: at least 11.0g/dl
         • Weight: at least 25 kg
         • No h/o severe heart and lung disease,
           abnormal bleeding tendency
         • No bacteraemia at time of donation
         • No h/o hepatitis B/C or HIV
         • Cancer not a contraindication
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                            Role of Erythropoietin in
                             Autologous Donation

        • Allow more units to be collected.
        • Double blind trial
          – I/V EPO 600 IU/kg body weight 2X/week
             or a placebo.
          – taking adequate iron supplement
          – EPO group donated an average of 5.4
             units, placebo group, average of 4.1
             units
                  Goodnough et al Transfusion 1992;32:441-445
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                            Role of Erythropoietin in
                            Autologous Transfusion

             Limitation:
         • Need two to more weeks to work.
         • Expensive.
         • May suppress endogenous
           erythropoietin up to one week.
         • May increase risk of thrombosis and
           hypertension.
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                            Autologous Blood Donation
                                During Pregnancy
      Indications: high risk of bleeding (eg placenta
       praevia), alloimmunisation.
      Contraindication: impaired placental flow, IUGR.
      Labour ward with continuous CTG monitoring.
     • Potential risks of
        – premature labour
        – fetal complications in impaired placental flow
        – may not be able to avoid allogeneic blood.


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                            Singapore Programme

         • Started since 1987
         • Bloods are either collected at the Centre for
           Transfusion Medicine (private/smaller
           hospitals) or at autologous clinics in the
           hospitals (TTSH, KKH). Teaching hospitals
           collect their own autologous blood
         • Cases: maxilo-facial, orthopaedics,
           obs/gynae, general surgery, urology

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               Autologous Collection in the past 5 yrs
     Type of Autol     2001 2002 2003 2004               2005
     Transfusion
     Preop                  959   776   666     675      547
     Autologous
     Intraop                401   390   360     296      208
     Haemodilut
     Intraop Cell           80    123   395     98       104
     Saver
     Postop                 NA    269   49      17       7
     Salvage
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                            High-risk Autologous Clinic

         • Pilot project with Dept. of Anaesthesia
           and Dept. of Haematology, SGH
         • For older patients (<75 years)
         • For patients with IHD
         • For patients with h/o epilepsy


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                               Autologous
                               Blood Transfusion




        Pre-surgical Autologous Blood
         Donation
        Normovolemic Haemodilution
        Intraoperative Cell Saver
        Postoperative Blood Salvage

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                            Points to consider

         • Cost
         • Surgeon and Anaesthetist enthusiasm
         • Availability of allogeneic blood
         • Which types of procedures: cardiac;
           “clean operations”
         • Public awareness

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         CENTRE FOR TRANFUSION MEDICINE




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