Autotransfusion

Question 1

Autotransfusion

Answer 1

person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood.

Question 2

There are two main kinds of autotransfusion:

Answer 2

Blood can be autologously “pre-donated” (termed so despite
“donation” not typically referring to giving to one’s self)
Alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device
(such as a Cell Saver).

Question 3

Cell saver

Answer 3

ntraoperative cell salvage machine suctions*, washes, and filters blood so it can be given back to the patient’s body instead of being thrown away.
Because the blood is recirculated, there is no limit to the amount of blood that can be given back to the patient.

Question 4

Aspiration Set

Answer 4

Usuallypackagedseparatelyfromwashingset
• Duallumentube • Anticoagulant line with drip chamber and roller clamp control • Suction line for salvaged blood mixed with anticoagulant

Question 5

Anticoagulant

Answer 5

Heparinizedsaline(30,000unitsHeparin/1000mLsaline) • CPD(citrate-phosphate-dextrose) • ACD-A(anticoagulantcitratedextrosesolution-solutionA)

Question 6

Collection Reservoir

Answer 6

~3000to4000mLcapacity • Gross filter or 30-100 micron filter

Question 7

Bowl

Answer 7

Varyingsizesfrom50mLto250mL

Question 8

Fill phase

Answer 8

Centrifuge/accelerates to the speed selected on the
centrifuge speed control (typically 5,600 rpm). • The pump begins rotation, transferring
Reservoir contentswash bowl. • The application of centripetal acceleration* separates the
components of the fluid according to their weight (layering)
• Note: Centrifugal force does NOT exist

Question 9

The wash bowl filling continues until

Answer 9

he buffy coat

reaches the shoulder of the wash bowl.

Question 10

In the “auto mode” autotransfusion devices have

Answer 10

automatic buffy coat sensor, which is calibrated to detect a full bowl.
Fill phaseWash phase automatically
(really cool concept – BUT you will be running them in the manual mode at MWU)

Question 11

Wash phase

Answer 11

When the bowl is filled: The pump starts (clamps adjust)
wash solution  wash bowl
• Washing continues until the reinfuse/empty button is depressed (or the program ends and the predetermined amount of wash solution has been used)
• Effluent moves: wash bowl  waste bag
Manual mode note : watch for clear effluent

Question 12

Empty phase

Answer 12

The centrifuge stops, then transfers wash bowl  reinfusion bag.
• The cycle ends and a new cycle can begin • The reinfusion bag should not be used for direct pressure
infusion  patient • The reinfusion bag may contain air
Therefore, a separate blood bag attached to the reinfusion bag is used. disconnectair purgetied off
In accordance with Guidelines set by the American Association of Blood Banks (AABB) the blood should be reinfused within 4 hours from washing.

Question 13

Labeling Specimens

anesthesia and transport

Answer 13

• Patients Registration sticker • Type: i.e. WPRBC’s • Time collected • Time of expiration
• Volume • Initials

Question 14

Record Keeping

Answer 14

A signed autologus cellsaver record must be kept for every case
• All the input and output data is recorded
• Usually a single sheet that may contain: • Volume collected for reinfusion • Hematocrit of reinfusion volume (WPRBC’S)-QC* • Type & volume of wash solution used • Heparinized saline/CPD concentration & amount used • Date/time/patient information

Question 15

Indications

Answer 15

• Intended for use in situations to control blood loss • Recovery of blood lost during surgery • Rare blood groups without blood available • Risk of infectious disease transmission
• Autotransfusion is common intraoperatively/postoperatively. • Recovery of blood in the extracorporeal circuit at the end of
surgery or from aspirated drainage.
Post protamine
CPB circuit salvage ICU Pre-washing PRBC’s for pediatrics

Question 16

Advantages

Answer 16

• High levels of 2,3-DPG • Normothermic • pH relatively normal • Lower risk of infectious diseases • Functionally superior cells
• Lower potassium (compared to stored blood) • Quickly available

Question 17

Substances washed out

Answer 17

• Plasma • Platelets • WBC’s • Anticoagulant solution • Plasma free hemoglobin • Cellular stroma • Activated clotting factors • Intracellular enzymes • Potassium • Plasma bound antibiotics

Question 18

CONTRAINDICATIONS

Answer 18

Presence of bacterial contamination of the surgical site • Malignancy of the surgical area • C-section (obstetrics) • Topical hemostatic agents

Question 19

Contamination of the surgical site

Answer 19

• Any abdominal procedure poses the risk of contamination
• 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. (standby w/ reservoir*)
• If the blood is contaminated the entire contents should be discarded.
If the patient’s life depends upon this – it may be reinfused with the surgeon’s consent.
Large amounts of a 0.9% NS will reduce the bacterial contamination of the blood, it will not be totally eliminated

Question 20

Malignancy

Answer 20

• The possibility exists of reinfusion of cancer cells from the surgical site
There are possible exceptions to this contraindication: • Removal of an encapsulated tumor is possible.
Blood may be aspirated from the surgical site, processed and reinfused with the surgeon’s consent.
• If an inadequate supply of blood exists WPRBC’s may be used to support the patient with the surgeon’s
consent.

Question 21

Obstetrics

Answer 21

Not normally used in Caesarean sections
possibility of an amniotic fluid embolism exists.
• Emerging literature suggests that amniotic fluid is being cleared during the wash cycle
It is possible that the utilization of autotransfusion in obstetrics may increase as more research is completed
• In a Jehovah’s witness patient, for example, the cell saver can be used with strict guidelines of irrigating profusely to remove amniotic fluid and then suctioning the blood that is being lost.

Question 22

Topical Hemostatic Agents

Answer 22

Avitene, Helistat, Hemopad, Instat, or collagen type products
• Waste or wall suction source must be used. • Autotransfusion can be resumed once these products are
flushed from the surgical site.
• If Gelfoam, Surgicel, Thrombogen or Thrombostat are used, autotransfusion possibly can continue
direct suctioning of these products should be avoided

Question 23

Contraindications a perfusionist
(like your future self)
is most likely to encounter

Answer 23

• Wound infections • Pleural effusion • Betadine • Warm solutions • Sterile water
• Malignancy • Topical hemostatic agents

Question 24

Disadvantages

Answer 24

Depletion of plasma and platelets Removes plasma/platelets to eliminate activated clotting factors and
activated platelets (causes coagulopathy if reinfused) This disadvantage is evident when very large blood losses occur
• Typically, patient may require FFP/platelets when:
estimated blood loss > half of the patient’s blood volume. • Must test to determine the need for blood products

Question 25

Special Considerations -

Orthopedic

Answer 25

Antibiotics which are plasma bound can be removed, topical antibiotics which are not plasma bound may not be washed out
may actually become concentrated to the point of being nephrotoxic.
• Cement is often used or encountered during primary or revision total joint replacement surgery. Cement in the liquid or soft state should not be introduced into the autotransfusion system.
The use of ultrasonic equipment during revision of total joints changes the cement to a liquid or soft state precluding autotransfusion during the use of such equipment.

Question 26

Special Considerations -

Emergency

Answer 26

In life saving situations with the consent of the surgeon, autotransfusion can be utilized in the presence of the previous stated contraindications i.e. sepsis, bowel contamination and malignancy.

Question 27

IBBM-CPBMT Certification

Answer 27

Currently, the International Board of Blood Management is the governing body for certification in
autotransfusion (CPBMT). The IBBM’s mission is to promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management.
In order to become a Certified Perioperative Blood Management Technologist (CPBMT)
• Have a minimum of a high school diploma/ equivalent • Be practicing in the field of blood management for a
minimum of one (1) year • Complete fifty (50) autotransfusion procedures/yr.
Questions?