Transcript CLS 2215 Principles of Immunohematology

‫بسم هللا الرحمن الرحيم‬
Autologous Blood
BY
Ahmad Shihada Silmi,Msc, FIBMS
Lecturer of Haematology & Immunology
Faculty of Science, IUG
Autologous Blood
• Definition: An autologous donor is
one who is donating blood for his
or her own use.
Types of Autologous
Transfusion
• Pre operative donation.
• Acute normo-volumic hemodilution.
• Intra-operative salvage.
• Post operative salvage.
Autologous Blood
Autologous Transfusion Options
• Preoperative collection
– Blood is collected and stored prior to anticipated
need.
• Perioperative collection and administration
– Acute normovolemic hemodilution: Blood is collected
at the start of surgery and then infused during or
after the procedure
– Intraoperative collection: Shed blood is recovered
from the surgical field or circulatory device then
infused.
– Postoperative collection: Blood is collected from the
drainage devices and reinfused to the patient.
Donor Criteria
• Age – No age limits exist.
• Weight – No strict weight limits exist. Must
adjust volume of anticoagulant for donors
under 50 Kgs
• Hemoglobin and hematocrit – Hemoglobin
should not be less than 11.0 gm/dl and
hematocrit not less than 35.3%
Autologous Blood
• Each type of autologous transfusion has
potential risks and benefits.
• However, when feasible, the patient
should have the option to use his or her
own blood.
• Patients who are to undergo a procedure
that is likely to require transfusion who
meet the donation criteria SHOULD be
informed of the option for autologous
donation/transfusion, including the risks
and benefits.
Advantages
1
2
3
4
5
6
Prevent transfusion TTDs
Prevent red cell allo-immunization
Supplements the blood supply in BTS
Provide soln. to patients with allo-antibodies
Prevent adverse transfusion reactions
Provide soln. to religious belief (Jehovah's
witness)
Disadvantages
12345-
Same risk of bacterial contamination
Costlier than allogenic blood
Wastage of blood, if not switched over.
Chances of unnecessary transfusion
Subjects patient to perioperative anemia
& increase likelihood of transfusion
Autologous Blood Donation
Advantages
Disadvantages
1. Prevents transfusiontransmitted disease
1. Does NOT affect risk of bacterial
contamination
2. Prevents red cell
alloimmunization
2. Does NOT affect risk of ABO
incompatibility
3. Supplements the blood supply
3. Is more costly
4. Provides compatible blood for
patients with alloantibodies
4. Results in more waste
5. Prevents some adverse
transfusion reactions
5. Increased risk of volume overload
after transfusion
6. Subjects patient to perioperative
6. Provides reassurance to patients
anemia and increase likelihood of
concerned about blood risks
transfusion
Preoperative Autologous
Blood Collection
• Should be stable patients who are
scheduled for a surgical procedure
in which blood transfusion is
probable.
– Such as major orthopedic procedures,
vascular surgery, cardiac or thoracic
surgery and radical prostatectomy
Special Patient Categories
• Pediatric patients
– Only with suitable volume modification (blood
collected), parental cooperation and
attention to preparation and reassurance
• Patients with significant cardiac disease
are considered poor risks
• Serious consideration for women with
alloantibodies to multiple or high
incidence antigens, placenta previa, or
other ante- or intrapartum hemorrhage.
Preoperative Autologous Blood
• Transmissible Disease Testing (HIV,
HCV, HBV, etc.)
– NOT required unless it is to be used for
allogeneic transfusions
Preoperative Autologous Blood
Blood Bag Labeling
• Must be labeled: “Autologous Donor”
• If any testing is reactive on a current
collection or within the last 30 days it
must also be labeled “Biohazard”
• Untested autologous units must be
labeled “Donor Untested”
• If the blood tested negative within the
last 30 days it must be labeled “Donor
Tested Within the last 30 Days”.
Autologous Sticker
The Process
• Supplemental Iron
– Supplemental iron should be prescribed by
the requesting patients physician
– Ideally prescribed before the collection of
the first unit with sufficient time to allow
for the patients marrow to reconstitute all
or a significant portion of the donated RBC
volume.
– This is NOT usually the case, though.
The Process
• Collection
– Request is made in writing by the requesting
patients Physician
– Request form is kept in the collecting
facility
• Should include name, unique identification
number, number of units, surgical procedure, and
physicians signature.
• Schedule of Blood Collections
– Depends on the number of units requested
– As far ahead of the scheduled surgery as
possible. Why?
Donor Criteria
• Frequency – Not more than every three
days with the final donation completed
at least 3 days before surgery.
• Medical History – Should be tailored to
the needs of the donor. Such as
questions about medications, associated
medical illnesses and cardiovascular risk
factors.
Pre-op Autologous Donation (3)
Contraindications:
1 Evidence of infection and risk of bacteremia
2 Scheduled surgery to correct aortic stenosis
3 Unstable angina
4 Active seizure disorder
5 Myocardial infarction or CV accidents
6 Significant cardiac or pulmonary disease
7 Cyanotic heart disease
8 Uncontrolled hypertension
9 Malignant diseases
How to collect Autologous Blood