Intra_operative_bloo..

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AUTOLOGUS
BLOOD
TRANFUSION
Advantages of autologous
blood
Prevents transfusion-transmitted
disease
Prevents red cell alloimmunization
Supplements the blood supply
Provides compatible blood for patients
with alloantibodies
Prevents some adverse transfusion
reactions
Provides reassurance to patients
concerned about blood risks
AUTOLOGUS
BLOOD
TRANFUSION
Comparison
Parameter
pH
Plasma hemoglobin
(mg/dL)
Plasma potassium
(mEq/L)
Plasma sodium
(mEq/L)
Blood dextrose
(mg/dL)
2,3Diphosphoglycerate
(µM/mL)
Percent survival *
Autologus
blood
7.55
35 (Whole
Blood)
6.73
0.5
46
4.2
17.2
169
153
440
282
13.2
1
—
79
Autologus Transfusion
AUTOLOGUS
BLOOD
TRANFUSION •PAD/SFDN-Pre op autologus
TYPES donation.
•ANH-Acute normovolumic
hemodilution
•ICS-Intra operative cell
salvage
ICS
Intra op
cell
salvage
Intra operative cell
salvage
•The technique of
collecting and
reinfusing blood lost
by a patient during
surgery.
HISTORY •Management of severe, rapid
ICS
Intra op
cell
salvage
blood loss
•Reported in 1917
•Started as life saving
procedure than regular.
•Most cases were hemothorax
& turp
•1970-Bently autotranfusion
system
•1974-Hemonetics cell saver
TYPES
Blood salvage procedures
Three general types of
salvage procedures:
1.Cell processors and salvage
devices that wash and save
red blood cells, i.e., "cell
washers" or RBC-savers
2.Direct transfusion
3.Ultrafiltration of whole
blood
Cell processor
Method
Cell processor
Method
Method
1.COLLECTION
•Using a dual lumen tube,
anticoagulant is fed to the
operation site to be mixed
immediately with shed blood
and sucked away.
•The choice of
anticoagulant either
Heparin or Citrate.
Method
2.STORAGE
•Blood and anticoagulant are
carried into a sterile reservoir by
vacumm.
•It is filtered to remove large
clots and debris.
•Most collection reservoirs have a
filter in the 40-150 micron
range.
•Between 1:5 and 1:10 ratio of
anticoagulant to collected blood.
Method
3.CENTRIFUGE
Blood and anticoagulant are drawn
from the collection pot into a
centrifuge to be processed.
The force supplied by the centrifuge
holds the more dense red blood cells
against the outer wall of the bowl.
The less dense white blood cells,
platelets, plasma and anticoagulant
move towards the centre of the bowl
where they spill over into a waste
bag
Method
4.washing
Blood is washed with a
saline solution and red
blood cells are separated
from waste products.
A sterile isotonic saline
solution is pumped into the
centrifuge bowl. Only a
0.9% sterile normal saline
is recommended.
Method
5.Waste separation
Waste products include
white blood cells,
platelets, plasma,
anticoagulant, fat and free
plasma haemoglobin.
These are collected in a
bag.
Method
6.Processed RBC
Packed red blood
cells are separated
from waste products
and collected in a
separate bag
Method
7.Reinfusion
Red blood cells can then
be reinfused immediately
or taken to recovery or the
Ward to be reinfused later.
There is, however, a limit
of 6 hours during which
reinfusion can take place.
CELL SAVER
DEVICES
1
Practical
considerations
. If not transfused immediately, units collected from a
sterile operating field and processed with a device for
intraoperative blood collection that washes with 0.9% saline,
USP, shall be stored under one of the following conditions
prior to initiation of transfusion:
At room temperature for up to 4 hours after terminating
collection;
At 1–6° C for up to 24 hours, provided that storage at 1–
6° C is begun within 4 hours of ending the collection.
2. Transfusion of blood collected intraoperatively by other
means shall begin within 6 hours of initiating the collection
3
. Each unit collected intraoperatively shall be labeled with
the patient's first name, last name, and hospital identification
number; the date and time of initiation of collection and of
expiration; and the statement "For Autologous Use Only."
4
. If stored in the blood bank, the unit shall be handled like
any other autologous unit.
Ultrafiltration
of Whole
Blood
Ultrafiltration
•Hemofiltration or ultrafiltration devices
filter the patient's anticoagulated whole
blood.
•The filter process removes unwanted excess
non-cellular plasma water, low molecular
weight solutes, platelet inhibitors, and some
particulate matter including activated
cytokines, anaphylatoxins, and other waste
substances through hemoconcentration; thus
making concentrated whole blood available
for reinfusion.
• Hemofilter devices return the patient's
whole blood with all the blood elements and
fractions including platelets, clotting
factors, and plasma proteins with a
substantial Hb level.
Ultrafiltration
of Whole
Blood
Ultrafiltration
These devices do not totally
remove potentially harmful
contaminants that can be
washed away by most RBCsavers
That coagulation and
homeostasis are immediately
improved with the return of
concentrated autologous whole
blood
DIRECT
TRANFUSION
Direct transfusion
Direct transfusion is a blood salvaging
method associated with cardiopulmonary
bypass (CPB) circuits or other
extracorporeal circuits (ECC).
Following bypass surgery the ECC circuit
contains a significant volume of diluted
whole blood that can be harvested in
transfer bags and re-infused into
patients. Residual CPB blood is fairly
dilute ([Hb] = 6–9 g/dL) and can also
contain potentially harmful
contaminants such as activated
cytokines, anaphylatoxins, and other
waste substances
Thank you
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