Heterologous blood transfusions are those that involve someone infusing blood and its components from a different species. Withdrawal, storage and preservation, and re-infusion of blood products are carefully regulated in the health industry because infusion of infectious, old, or incorrectly matched blood could result in hospitalization and possibly death.
Our website uses cookies. We use anonymous data provided by cookies to give you the best website experience possible, including integration with social media. A semi-continuous system may be used where blood is simultaneously scavenged, anticoagulated and washed ready for reinfusion. Smaller volumes of blood can be processed with this system.
Simple single use reservoir bags, which are attached to surgical drains to collect blood lost after the operation. After red cell collection the blood must be processed before reinfusion. These techniques can be divided into separation and filtering.
In cell separation washing , RBCs are separated by centrifugation. This occurs in a rotating separation chamber where the salvaged blood is washed with — ml saline and then spun to produce packed RBCs of a preset haematocrit.
This concentrate is transferred to infusion bags and waste products drained from the system. After each cycle, the process can be repeated by adding more blood from the reservoir canister. In the semi-continuous device, a double spiral separation chamber is used.
Blood is pumped into the inner loop where low density material is expelled. The RBCs move by centrifugal force towards a continuously spinning outer spiral, which is washed with saline.
As all steps occur simultaneously, small amounts of blood can be processed. The filtering devices are much simpler and only suitable for oozing blood rather than brisk haemorrhage.
For this reason, the technique is largely confined to PoCS. No other processing or washing occurs. The procedure can be carried out for up to 12 h after operation or until a maximum of ml is transfused. Combined intra- and postoperative cell salvage is increasingly used for joint replacement surgery. Collection and washing of blood starts intraoperatively and continues postoperatively as the patient and machine are transferred to the recovery ward where collection from postoperative drains continues.
Red blood cells which would have been lost are scavenged and reinfused. The technique provides a supply of red blood cells in proportion to the losses and theoretically an unlimited amount of blood may be collected, processed and returned to the patient. It is therefore the technique of choice when large blood losses are expected and becomes increasingly cost-effective with large volume losses.
It has an excellent long-standing safety record. PoCS utilizes simple and inexpensive collection and retransfusion devices. This provides a cost-effective means of reducing the requirement of allogenic blood transfusion.
Cell salvage is accepted by some Jehovah's Witnesses. ICS requires complex specialized equipment resulting in high initial capital expenditure and ongoing costs of disposables.
A high level of training is required for the operator. The process is complex and can result in serious complications see below. The blood salvaged may contain cell debris, free haemoglobin and micro-aggregates. The technique is contraindicated in patients with sepsis and in contaminated surgery, for example bowel surgery.
The use of cell salvage in malignant disease and obstetrics remains controversial see later. When large volumes of salvaged blood are retransfused, significant changes in haematological parameters may occur including the following:. Electrolyte disturbances such as increased concentration of sodium and chloride and reduced magnesium, calcium and albumin. Dilutional coagulopathy as washed blood does not contain platelets or clotting factors.
This may require blood-component therapy. DIC salvaged blood syndrome. Incorrect use of washing and filtration devices may result in red cell destruction. Eur Surg Res ; —, doi: The effect of storage on the survival of cancer cells in blood and efficient elimination of contaminating cancer cells by a leukocyte depletion filter. Am Surg ; — However, other studies have revealed that it can be safely applied to certain tumor surgeries 39 Recommendations for the transfusion management of patients in the peri-operative period.
The intra-operative period. Predicting the necessity of autologous blood collection and storage before surgery for hepatocellular carcinoma. J Surg Oncol ; —, doi: Research advances in the application of intraoperative, salvaged and autologous blood transfusion in major oncologic surgery.
Preoperative autologous blood donation versus intraoperative blood salvage: intraindividual analyses and modeling of efficacy in patients. Currently, traditional approaches of autologous whole blood transfusion such as leapfrog and step-by-step accumulation approaches continue to be applied at most hospitals. However, traditional approaches of preoperative blood storage also have many shortcomings: large blood volume, low concentration of blood components, especially platelets, and high adverse reaction rate.
Autologous transfusion. BMJ ; —, doi: Furthermore, traditional autologous transfusions require blood donation to be conducted at least once a week before surgery. The "leapfrog" method requires donations at least one month in advance, and the step-by-step accumulation method requires blood collection 20 days in advance. These methods and concepts are contrary to the requirements of hospitals in terms of the average number of hospitalization days, preoperative preparation days and other indexes, restricting the implementation and popularization of ABT 44 Chen L, Zhou XD.
The clinical research progress of autologous blood transfusion. Internal Med China ; 8: — Thus, ABT techniques and concepts urgently need to be further explored and researched, especially in blood collection methods and timing, in order to highlight the role of ABT in clinical transfusion.
Blood cell separation technology began in the s, and has been used in clinic for many years mainly for hematopoietic stem cell collection, granulocyte collection, plasmapheresis, blood component removal and other therapeutic uses 45 Intraoperative use of platelet-plasmapheresis in vascular surgery.
J Clin Anesth ; 10—14, doi: Platelet-rich plasma gel promotes differentiation and regeneration during equine wound healing. Exp Mol Pathol ; —, doi: This technology is widely used for allogeneic blood component collection such as platelets, plasma and erythrocytes 47 Red blood apheresis of COM.
TEC blood cell separators for therapentic clincal observation. Chinese J Clin ; 9: — In preoperative autologous transfusion, this technique can be used to collect red cell and platelet concentrate, and plasma, according to the patient's requirements. These components are separately stored according to their respective preservation requirements in order to maintain their physiological activity 48 Apheresis application of predeposit auotransfusion in surgical operation.
Chinese J Med ; 32—35, doi: At the same time, since the liquid volume that flows in and out the body is kept in balance, this technology can ensure the safety of blood components collection. In addition, only concentrated blood components are collected; thus, the blood volume in patients before and after the collection does not significantly change.
Therefore, this technology has a secure and efficient advantage when applied in preoperative autologous transfusions. Using a blood apheresis apparatus, 2 units or more of red blood cells can be collected in one time.
In a comparative study, 2 units of red blood cells were collected in two ways: whole blood collection and apheresis collection. Results revealed that in the apheresis collection, only the concentrated blood components were collected and the blood volume of the patient did not significantly change before and after the collection, thereby ensuring safety 48 Transfusion of pre-stored apheresis autologous red blood cell in retroperitoneal tumor elective surgery.
Labeled Immunoassays Clin Med ; — Compared with whole blood collection, patients who underwent apheresis had fewer hospitalization days, faster recovery of postoperative hemoglobin levels, and lower incidence of adverse reactions. However, at present, the collection of more than 2 units of autologous erythrocyte or other blood components using a blood apheresis apparatus has not been reported.
Some scholars believe that in preoperative autologous transfusion, apheresis collection of larger amounts or multi-component collection is a very promising pattern that could replace whole blood collection.
Using existing techniques, the preservation time of platelets is short. This is another reason for restricting the development of preoperative ABT. Platelets collected using tubes made in China can be stored for 1—3 days, while storage using imported tubes lasts 5—7 days.
Therefore, it is necessary to improve platelet storage technology to extend autologous platelet storage time. Platelet cryopreservation technology has continuously gained more attention worldwide. In order to avoid damaging the platelet membrane during cryopreservation, which affects platelet function after rewarming, a cryoprotectant must be added.
Dimethyl sulfoxide DMSO is a cryoprotectant, as well as an enhancer of cell fusion and permeability 50 Review of in vivo studies of dimethyl sulfoxide cryopreserved platelets. Transfus Med Rev ; —, doi: Response to the article on dimethyl sulfoxide-cryopreserved platelets published in Transfusion Medicine Reviews Volume 28 4.
China's Food and Drug Administration also indicates that DMSO can be used for the cryopreservation of platelets and stem cells, and for clinical infusion without washing. Several concerns regarding the urgent use of autologous blood in trauma patients have been raised, including logistic issues for implementing an autotransfusion protocol, infectious complications due to transmission of contaminated blood, exacerbation of coagulopathy, and cost-effectiveness.
Although the use of autologous transfusion in the elective setting allows preoperative planning and preparation, its application in trauma does not have the luxury of time, which may limit its use in many trauma centers. Our trauma center has a perfusionist on call 24 hours a day, 7 days a week, 52 weeks a year. At the discretion of the trauma surgeon and at the time a decision to go to the operating room has been made, the perfusionist is called in to support and coordinate intraoperative CS and autologous transfusion.
While the perfusionist is on the way to the hospital, the operating room team sets up and primes the CS system so that the system is functioning at the beginning of the operation. Once the perfusionist arrives, the intraoperative CS and reinfusion proceeds as described previously. Trauma programs not currently using autologous transfusion should set up a multidisciplinary protocol to allow efficient activation and implementation of intraoperative CS and autologous transfusion during urgent operations for trauma patients.
Concerns for infectious complications following the collection and reinfusion of contaminated blood may dissuade surgeons from implementing an autologous transfusion program, especially during laparotomy for trauma, in which enteric violation is common.
Although our study did not specifically address this issue, many authors have challenged the dogma that contaminated blood cannot be autotransfused in the trauma setting.
Even one of the earliest reports of CS and autotransfusion mentioned the reinfusion of contaminated blood. Griswold and Ortner 11 concluded that giving grossly contaminated blood was better than giving no blood at all. While few would argue with that statement, the question arises of what to do with contaminated blood salvaged intraoperatively when allogeneic transfusion is available.
Although early reports of autotransfusion of unprocessed, contaminated blood were associated with high mortality rates, 3 more recent studies have found that the bacterial load can be nearly eliminated with current cell-washing techniques. Most of the series published to date have included patients autotransfused with contaminated blood and have not identified increases in infectious complications for those patients.
In addition, there was no increase in septic morbidity or mortality in patients who received autotransfusion with contaminated blood. Based on the existing literature, it appears that contaminated blood from intraoperative CS and cell washing can be reinfused without increasing the risk of infectious complications.
Another obstacle to using CS and autologous transfusion is the concern for exacerbating coagulopathy in an actively bleeding patient.
Similarly, Bowley et al 18 found no difference in rates of coagulopathy when they compared autologous with allogeneic transfusion. Most of the data implicating autologous transfusion as a causative factor for coagulopathy arise from animal studies and after reinfusion of unprocessed CS blood 3 ; however, on review of the current literature, it does not appear that reinfusing collected and washed red blood cells should lead directly to coagulopathy.
Nevertheless, as with any massive transfusion, that of large amounts of autologous blood may lead to a dilutional coagulopathy. In fact, Horst et al 15 found that coagulopathy occurred in patients receiving more than 15 U of autologous blood.
Furthermore, patients who received blood contaminated by enteric contents were more likely to develop coagulopathy. An additional limitation to the widespread use of CS and autologous transfusion is the associated cost. Hard conclusions regarding cost-effectiveness may be difficult to ascertain in our study because we did not include patients for whom CS was performed but not infused.
The most common reasons for performing CS and not reinfusing are inadequate collection of blood, concerns over reinfusing contaminated blood, and mortality prior to infusion of collected blood.
Cost-effectiveness is closely associated with the amount of autologous blood that can be autotransfused and the percentage of autologous blood in the total transfusion. Another way to look at the same question would be to determine how many units of autologous transfusion would be required to offset the cost of a similar allogeneic transfusion. To maximize the cost-effectiveness of intraoperative CS and autologous reinfusion, preoperative patient criteria need to be developed that identify patients who will require at least 2 U of autologous transfusion and who can maximize the percentage of intraoperative autologous blood used.
In conclusion, the present matched cohort study adds to the existing literature regarding the beneficial effects of intraoperative CS and autologous transfusion in trauma patients undergoing an emergency surgical intervention. Cell salvage is associated with fewer transfusions of PRBCs and plasma while providing a savings in total transfusion costs. Additional studies are needed to definitively confirm the safety of transfusing contaminated blood, to preoperatively identify patients who would most benefit from autologous transfusion, and to optimize cost-effectiveness.
In the meantime, centers with access to a CS program should routinely use autologous transfusion as part of their intraoperative resuscitation. More important, centers not currently using intraoperative CS and autotransfusion should identify and overcome barriers to implementing this life-saving technique. Correspondence: Carlos V.
Analysis and interpretation of data : Brown, Foulkrod, Biggan, and Manuel. Drafting of the manuscript : Brown, Foulkrod, Sadler, and Czysz. Critical revision of the manuscript for important intellectual content : Brown, Richards, Biggan, and Manuel.
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