Autotransfusion is the process by which a person receives his own blood for transfusion, instead of allogenic blood (separate donors). There are two main types of autotransfusion: Blood can be autologous "pre-donated" (so called although "donations" do not usually refer to giving to themselves) before surgery, or alternatively, can be collected during and after surgery using intraoperative blood-saving devices (such as Cell Saver or CATS). The latter form of autotransfusion is used in operations where there is the possibility of massive blood loss - eg. aneurysms, total joint replacement, and spine surgery.
The first documented use of "self-contributed blood" was in 1818, and interest in this practice continued until the Second World War, where the blood supply became less of a problem as the number of blood donors increased. Later, interest in the procedure returned with concerns about allogenic transfusions (separate donors). Autotransfusion is used in a number of cases of orthopedics, trauma, and heart, among others. Where appropriate, it brings certain benefits - including reduced risk of infection, and the provision of more functional cells that do not experience the significant storage periods common among allogenic blood products (donor separated) that are bound.
Video Autotransfusion
Histori
There is some evidence that in 1785 the Philip Physic of Philadelphia transfused postpartum patients. But the use of the first autologous blood transfusion was documented in 1818 when an Englishman, Rey Paul Blundell, saved vaginal blood from patients with postpartum hemorrhage. By wiping blood from the bleeding site and rinsing the swab with saline, he finds that he can re-enter the washing result. This simple method resulted in a 75% mortality rate, but marked the commencement of autologous blood transfusions.
As long as the American Civil War Union Army doctor is said to have given four transfusions. In 1886, J. Duncan used autotransfusion during amputation of the limb by removing blood from the amputated limb and returning it to the patient with femoral injection. This method was quite successful. A German, M. J. Theis, reported the first successful use of intraoperative autotransfusion in 1914, with ruptured ectopic pregnancy. The earliest reports in the American literature on the use of autotransfusion were by Lockwood in 1917 who used this technique during a splenectomy for Banti syndrome. The interest in unrefined autotransfusion techniques continued until the early 1940s, and was applied to various procedures including the treatment of ectopic pregnancy, hemothorax, splenic arousal, perforating stomach injury, and neurosurgical procedures.
Interest in autotransfusion shrank during World War II, when there were many donors. After the war, blood tests, typing, and crossbreeding techniques improved, making blood banks the answer to increased demand for blood. In the 1960s, interest in autotransfusion was revived. With advances in all areas of operation, the new company developed an autotransfusion device. Problems still arise, however, with air embolism, coagulopathy, and hemolysis. The tools used during the Korean and Vietnamese Wars were collected and provided dirty blood filtering before being re-inserted. With the introduction of cardiopulmonary bypass in 1952, autotransfusion became a field of study. Klebanoff started a new era of autotransfusion by developing the first commercially available autotransfusion unit in 1968. The system, the Bentley Autotransfusion System absorbs, collects, filters and infects all autologous blood shed from the operative field. Problems with the Bentley system include the patient's systemic anticoagulant requirements, the introduction of air embolism, and kidney failure resulting from nonfiltered particles in the reinfused blood.
Because the Bentley system lost support, Wilson and colleagues proposed the use of a discontinuous flow centrifuge process for autotransfusion that would wash red cells with normal saline solution. In 1976, the system was introduced by Haemonetics Corp and is known generally as "Cell Saver". Recently in 1995 Fresenius introduced a sustainable autotransfusion system.
There are three types of systems: unwashed filtered blood; centrifugal severed flow; and continuous flow centrifuges. Unwashed systems are popular because they consider inexpense and simplicity. However, unwashed systems can lead to increased potential for clinical complications. The washed system requires clinically trained and skilled operators. It only restores red blood cells suspended in salt and is rarely associated with clinical complications. Interrupted autotransfusion can practically eliminate the need for exposure to homologous blood in elective surgical patients and can greatly reduce the risk of exposure in emergency surgical patients.
Maps Autotransfusion
Medical indication
Autotransfusion is intended to be used in situations characterized by the loss of one or more units of blood and may be highly beneficial for use in cases involving rare blood groups, the risk of transmission of infectious diseases, limited homologous blood supply or other medical situations where homologous blood is used contraindicated. Autotransfusion is commonly used intraoperatively and postoperatively. Intraoperative autotransfusion refers to recovery of blood loss during surgery or fluid concentration in the extracorporeal circuit. Postoperative autotransfusion refers to blood restoration in extracorporeal circuits at the end of surgery or from aspirated drainage.
Benefits
- High level 2,3-DPG
- Normothermic
- The pH is relatively normal
- Lower your risk of infectious diseases
- Functional superior cells
- Lower potassium (compared to stored blood)
- Available quickly
Substances washed
- Plasma
- Platelets
- White cell
- Anticoagulant solution
- Plasma free hemoglobin
- Mobile stroma
- Active clotting factor
- Intracellular enzyme
- Potassium
- Plasma-bound antibiotics
Loss
The disadvantages of autotransfusion are thinning of plasma and platelets. The washed autotransfusion system removes plasma and platelets to eliminate active clotting factors and activated platelets that will cause coagulopathy if they are reinfused to the patient, resulting in a red blood cell (PRBC) product. This loss is only evident when very large blood loss occurs. Autotransfusionist monitors blood loss and will recommend fresh frozen plasma (FFP) transfusions and platelets when blood loss and the return of increased blood autotransfusion. Usually patients will need FFP and platelets as an estimate of blood loss exceeding half of the patient's blood volume. When possible diagnostic tests should be performed to determine the need for blood products (ie PRBC, FFP and platelets).
Contraindications
The use of recovered blood from the surgical field is contraindicated in the presence of bacterial contamination or malignancy. The use of autotransfusion in the presence of such contamination may lead to the spread of pathological microorganisms or malignant cells. The following statements reflect current clinical problems that involve contraindications to autotransfusion.
Contamination of the surgical site
Any abdominal procedure poses the risk of contamination of the intestines from blood being shed. The surgical team should be diligent in observing signs of intestinal contamination in the blood. If there is any question about the possibility of contamination, the blood may be withheld until the surgeon determines whether the intestinal contents are not present in the surgical field. If blood is contaminated, all contents must be removed. If the patient's life depends on this blood supply, then it may be reinfected with the surgeon's approval. When washing with a large amount of sodium chloride solution will reduce bacterial contamination from the blood, it will not be completely eliminated.
Malignancy
There is the possibility of reinfusing cancer cells from the surgical site. There may be exceptions to this contraindication:
- The surgeon feels that the removal of a fully coated tumor is possible. Blood can be sucked from the surgical site, processed and prescribed with the approval of the surgeon.
- If an inadequate blood supply exists, the washable red cells can be used to support the patient's vital signs with the surgeon's approval.
Use of leukocyte reduction filters is recommended.
Obstetrics
Autotransfusion is not usually used in cesarean section, because of possible amniotic fluid embolism. Appear literature shows that the amniotic fluid is being cleaned during the washing cycle. It is possible that the utilization of autotransfusion in midwifery may increase as more research is completed. However, if a patient is at risk of blood loss and is a Jehovah's witness, for example, cell savers can be used with very strict watering guidelines to remove amniotic fluid and then suck up the lost blood.
Emergency
In a life-saving situation with the approval of the surgeon, autotransfusion may be used in the presence of previously stated contraindications of sepsis, intestinal contamination and malignancy.
Collection and processing of blood
Utilizing a special double lumen suction tube, the liquid is aspirated from the operating area and mixed with an anticoagulant solution. The collected fluid is filtered in a sterile cardiotomy reservoir. The reservoir contains a filter and has a capacity between two and three liters of liquid. When enough volume to fill the washing bowl has been collected, processing can begin. The volume required to fill the bowl depends on the hematocrit (HCT) and the size of the bowl of the centrifuge. If the HCT patient is normal, the amount required to process the unit is approximately twice the volume of the bowl.
When aspirating blood, it is important to use the following techniques if possible:
- Sucking blood from the pool rather than skimming.
- Keep the suction tip below the air-blood interface level.
- Avoid clogging the suction tip (eg using suction as retractors).
Following this technique will help reduce red blood cell hemolysis and will help increase the number of red blood cells that will be saved.
Special considerations
Antibiotic irrigation
Plasma-bound antibiotics can be eliminated during autotransfusion wash cycles, but topical antibiotics typically not bound to plasma can not be washed during autotransfusion, and may actually become concentrated at the nephrotoxic point.
Topical coagulant products
When Avitene, Hemopad, Instat, or any type of collagen product is used, autotransfusion should be disrupted and waste or wall sucking sources should be used. Autotransfusion can be continued after the product is flushed from the surgical site. If Gelfoam, Surgicel, Thrombogen or Thrombostat is used, autotransfusion may continue, but direct suction of this product should be avoided.
Orthopedic bone
Cement is often used or encountered during total joint replacement surgery or revision. Cement in a liquid or soft state should not be incorporated into the autotransfusion system. When cement is being used the source of waste or suction wall should be used, but when the cement hardened autotransfusion can be continued. The use of ultrasonic equipment during the total revision of the connection changes the cement into liquid or soft, preventing the use of autotransfusion during the use of such equipment. Autotransfusion can only continue when the cement hardened.
Processing
Prime phase
In the prime phase, the centrifuge begins to spin and accelerates to the selected speed at a centrifuge speed control, typically 5,600 rpm. At the same time, the pump begins rotation counterclockwise, allowing the transfer of the contents of the reservoir to the washing bowl. The centrifugal force application separates the fluid components by weight. Fill the washing bowl hold until the buffy coat reaches the shoulder of the washing bowl. Some autotransfusion devices have automatic features including buffy coat sensors, which are calibrated to detect the full bowl and advance the process to the wash phase automatically.
Washing stage
The washing stage begins when the washing bowl is filled with red blood cells. The pump continues the rotation and clamp counterclockwise, allowing the transfer of washing solution to the washing bowl. The washing phase eliminates cell stromata, free hemoglobin plasma, anticoagulant solution, active clotting factor, any plasma bound antibiotic, intracellular enzyme, plasma, platelets, and white blood cells. The unwanted fluid comes out of the wash bowl and into the bag of wastewater dam. Wash and hold until reinfuse button is pressed (or program ends, in case of automatic device) and exact amount of washing solution has been sent to washing bowl. The washing phase is stopped when one to two liters of the washer solution has been transferred, or the liquid transferred to the waste bag appears transparent (or both).
Empty phase
When the empty phase begins, the centrifuge starts to brake. Clamps change position, allow transfer of washing bowl contents to reinfusion bag. The centrifuge bowl should really stop before the pump starts spinning clockwise to empty the bowl. After the bowl is emptied, the cycle will end and a new cycle can begin. The reinfusion bag attached to the autotransfusion wash set should not be used for high-pressure infusions back into the patient. The reinfusion bag contains a large amount of air, careful monitoring should be done during reinfusion to avoid potential air embolism. Therefore, it is recommended to use a separate blood bag attached to the infusion bag. This second bag can then be disconnected, the air is purged from it, and then tied up before an anesthesia is given for reinfusion. Thus reducing the possibility of air embolism. In accordance with the Guidelines set by the American Association of Blood Banks, blood should be infused within 4 hours of leaching.
Postoperative autotransfusion
Postoperative autotransfusion is done by connecting the double lumen autotransfusion suction line directly to the sewer placed at the end of the operation. Postoperative autotransfusion begins in the operating room when the drainage line is placed and the surgical site closes. A typical postoperative case is total knee and hip replacement. Autotransfusion is continued and effective when the patient is actively bleeding during the postoperative recovery phase. Autotransfusion is terminated when bleeding is stopped or significantly slow, and terminated by connecting its own usual drain device to the drain (s). Available for postoperative autotransfusion is a universal bifurcated connector that can accommodate two drain channels of any size, this connector can be attached to a standard ten-foot standard lumen suction line for postoperative use.
Soaking sponge
In some institutions to maximize the effectiveness of autotransfusion and provide the best preservation and return of red cells, sponge dipping is used. During the surgical procedure, the blood-soaked sponge is collected and placed in a sterile basin by the surgical team, sterile heparin sterilizing saline is added to the basin to prevent freezing and facilitate the release of red blood cells. Sponges are regularly squeezed and removed from the basin, the remaining solution may be aspirated into the autotransfusion reservoir so that the red blood cells can be recovered. The usual ratio of heparin-treated saline is 5,000 units of heparin per 1,000 ml of 0.9% sodium chloride. Heparin is removed during autotransfusion.
Society and culture
People of the Jehovah's Witnesses religion in particular refuse to receive donated blood homologously and autologously. However some individual members may accept the use of autotransfusion by using Cell Saver. The autotransfusion process using Cell Saver is modified to maintain a continuous blood circuit that maintains continuous contact with the body. This process when carefully explained to the patient is acceptable when the patient reverses on the basis of religious beliefs.
Autologous platelet and gel platelet removal
Many of the latest autotransfusion engines can be programmed to provide blood splitting into three groups; red blood cells, poor plasma platelets, and platelet-rich plasma. Blood can be taken from the patient just before surgery and then separated. Separated blood components that have been sequestered can be stored during the surgical procedure. Red blood cells and poor platelet plasma may be given back to the patient through intravenous transfusion during or after surgery. Plasma-rich platelets can be mixed with calcium and thrombin to create a product known as autologous platelet gel. It is an autologous product that can be used for a variety of techniques including use as a hemostatic aid, dural sealant, and aid for bone fusion.
See also
- Autotransfusionist
References
External links
Manufacturers of equipment
- Euroset
- Sorin Group
- Haemonetics
- Fresenius
- Davol
- Boehringer lab
Organization
- American Association of Blood Banks
- International Blood Management Board
- Society for Blood Management Progress
Source of the article : Wikipedia
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