Autologous Transfusion Flashcards
Talk a little about the history of autologous transfusion
A historic form of transfusion
Cell salvage the only kind of autologous really carried out at the moment but only done in specific hospitals with anaesthetitions trained to do so -> staff often loose their skills in this etc
Where is autologous countries most common?
Third-world countries
What are the four most common categories of autologous transfusion?
Pre-operative or pre-deposit autologous donation
Acute normo-volomaemic haemodilution - before surgery
Perioperative cell salvage
Postoperative blood salvage -> blood taken during infection etc and then given back
What is an autologous transfusion?
Whereby a patient’s own blood is taken and re-transfused back into them
Usually involves some form of processing before re-re-infusion e.g. anti-coagulation, cleannig, microbial testing, concentration etc -> sometimes the only processing will be adding saline
Still a listen product in the IBTS -> listed for rare blood groups but technically it means you could donate a unit and get it back
Why might someone go for an autologous transfusion?
Rare phenotypes or complex antibodies which make blood difficult to get
To prevent all-immunisation
Can be driven by fear e.g. in America where autolgous much more common -> it is considered a premium service in some hospitals -> avoiding infection but still at risk of getting wrong unit etc
What does PAD stand for?
Peri-operative autologous donation
What are the BSH guidelines surrounding PAD?
Only recommended for patients with rare blood groups of mutliple antibodies
Cell salvage interoperatively must not be possible
Optimising Hb/haematinics prior to surgery not possible
Why is PAD often pointless?
PAD is only recommended when no other options are avaialable
The patient must also have a high chance of needing blood
i.e. patient is often really unwell and will generally need a large transfusion therefore the two units taken pre surgery wont be enough anyways and patient ends up needing other blood ayways
The BSH guidelines surrounding autologous transfusion changed this year, what is different
Fear of allogeneic transfusion or in general getting blood was included as a viable reason for getting autologous
What is the main reason cell salvage might not be suitable?
If bacteria present in the site requiring salvage eg. bowel surgery
When would pre-deposit auologous transfusion be recommended, what are some benefits of it?
It reduces the need for allogneic transfusion -> good for rare types
It is most widely used in elective surgery
Evidence shows it is more cost effective than allogeneic and clinical outcome is improved
- no TRIM - especially significant in USA where LD not done on rcc
What is pre-operative or pre-deposit autologous donations (PAD)?
Usually fresh i.e. liquid or occassionally frozen donation
Unit taken before surgery etc
Least commonly used method of autologous
What is acute normovolaemic haemodilution?
Whereby blood is taken just before the surgery, replaced by fluids and returned after the operation
What is perioperative cell salvage?
Blood collected as shed dring surgery, processes at that time and returned to patient while recovering
Involves taking about a litre of blood and relacing it with colloids -> this means the patient is only losing colloids if they bleed during surgery
We usually increase the patients Hb before surgery as well to improve result
we then transfuse the blood back after the surgery
This is actually quite successful
What is postoperative blood salvage?
Drained blood from a wound is processed and returned
This is not widely practiced
Could be done if blood pools etc
In general what are the risks of autologous transfusion
Adverse effects may take a long time to manifest themselves and can post-date lifetime of the recipient
Some potential adverse effects such as IBCT are just as likely to occur wih alogeneic -> commonly dont realise autologous blood in fridge for patient and just given allogeneic
Difficult to balance potential use of autologous blood against fitness of donors to donate -> can be too sick to donate etc
Allogeneic transfusion may lead to an increased risk of postoperative bacterial infections and multi-organ failure e.g. TRIM
Give an example of where autologous blood transfusion was done regularly in Ireland
Kappa hospital
Used to donate 2 units prior to hip surgery
However EU directive stopped them doing this as it would have to make the hospital a blood establishment
-> hospitals in portugal do this
There was no problem with this though as it would still work today and it would probably be cheaper for hospitals -> an mpty pack is a lot cheaper than a full rcc
When was autologous transfusion high, what was its peak
1990s and early 2000
CJD fear increased autologous but very little concern with this nowadays
Peak in 1992 with 8.5% of rccs being autologous
Talk about SHOT reporting of autologous BT
Nowadays SHOT doesnt really get reports for autologous transfusion -> only get reports on cell salvage
Have to go back to 2006 for reports on autologous -> 6 cases in 2006
What three cases of autologous BT did we look at in detail?
High volume of salvaged blood re-infused
Hypotensive reacction using cellsaver
Febrile reaction to postoperatively salvaged blood
Talk in detail about the case where a High volume of salvaged blood re-infused
Post operative
58yr old female underwent bilateral knee replacement
Blood was salvaged bilaterally from a drain postoperatively in HDU
Hospital and manufacturer policy stated that a maximum of 1000mL could be reinfused but the HDU nurses reinfused 2280mL of the salvaged blood as they were unfamiliar with the process
There was no adverse reaction
Talk in detail about the case where of hypotensive reaction using cellsaver machine
82 yr old male underwent intraoperative cell salvage using cellsaver whilst he underwent vascular surgery
First unit was salvaged with no adverse reaction
Second unit was slightly under filled and when the patient was reinfused with it they became hypotensive, transfusion was stopped and vasoconstrictors were given, transfusion was restarted with same effects
Upon investigation of unit, CoNS grew- thought to be contaminants
Concluded that under-collection of units may have led to incorrect washing
Resolveed by amending policies and retraining staff accordingly
Talk in detail about the case of a febrile reaction to reinfused postoperatively salvaged blood
Minor febrile reaction to blood salvaged postoperatively
64 yrs old male who had been previously transfused on two occasions
600mls of blood collected via a Bellovac drain after knee replacement
Blood was reinfused over 4 hours and 30 minutes
patient developed an isolated febrile reaction but no investigations were performed
What are some criteria for suitability of pre-doposit autologous donation (PAD)
Patient selection -> not everyone is suitable
Nature of surgery - must require nlood
Hb not <11g/dl
Hct not <33%
No age limit
No strict weight limit
If patient is anaemic it can increase bleeding time
There is a much lower threshold for transfusion of pre-deopsited blood -> want to use if as it cannot be put back into normal stock -> unnecessary risk associated with this - pack could be contaminated etc
Who is not suitable for pre-deposit
If active infection
If heart condiiton e.g. angina
If HIV + -> wont risk having a HIV+/ve unit in the fridge
What are the indications for PAD?
Major orthopedic surgeries e.g. hip and knee replacement surgeries
Cardiovascular surgeries e.g. valve surgery
obstetric surgeries such as hysterectomy
Radical prostectomy or mastectomy
Gastro-surgery e.g. gall bladder, splenectomy etc
Pregnancy
NB: surgery must require 2 units according to MESBOS -> no point doing PAD if less needed ->no point if more will be needed
Talk about PAD for pregnancy
Done for rare blood types
Can give blood in advance of delivery
Units will be ready if theyre ever needed
Probably the only time we would use this in ireland
What are some issues with PAD
Cannot be done if active bacterial infection
A US study suggested that the risk of hospital admission was 10 times more with PAD -> potentially not enough blood? think about patient cohort though
Wastage - up to 50% of blood is wasted as it cannot be used for others
If surgery is cancelled etc then it can mean waste
- units have to be taken 4 weeks apart from each other
- delay in surgery can mean first unit is out of date as only 35 days
EU Directive imply need for blood bank establishment if PAD is carried out in hospital etc
Patient history NB -> medications can be problematic and cardiac problems
Units must be clearly labelled for patients - biohazard stickers might be needed
