Autologous Blood Transfusion

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Introduction
Autologous blood transfusion is the collection of blood from a
person and re-transfusion back to the same person when
required. This is in contrast to allogenic blood transfusion,
where blood from unrelated/unknown donors is transfused
to the recipient. The main aim for the use of autologous blood
transfusion is to reduce the risk of transmission of infection.
In 1937, Fantus proposed autologous donation (pre-
operative).
Methods of Autologous Blood Transfusion30,31
There are three methods of autologous transfusion.
• Cell salvage: Blood is collected from suction, surgical drains,
or both and re-transfused back to the patient after filtration
or washing.
• Pre-operative autologous donation (PAD): Blood is collected
in advance before an elective procedure, stored in the blood
bank and transfused back to the patient when required.
• Acute normovolaemic haemodilution (ANH): Blood is
collected immediately prior to surgery and blood volume is
restored by crystalloids or colloids. The blood is then re-trans-
fused towards the end of surgery once haemostasis is achieved.
Advantages
1. In patients with rare blood groups beneficial.
2. In autoimmune haemolytic anaemia, when compatible blood
is not available.
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3. To reduce transfusion of infections.
4. Cell salvage can be utilized when no alternative is available
to save the life.
Disadvantages: The use of autologous blood transfusion is not
without risk and complications. This adds to increased cost
and therefore should only be considered in certain situations.
Strict protocols and guidelines must be in place to ensure
patient safety.
Cell Salvage
This technique can be performed intra-operatively, post-
operatively or by both ways. The process involves collection
of shed blood from the surgical field. The salvaged blood is
then either filtered or washed and processed prior to re-
transfusion back to the patient in the immediate postoperative
period.
Advantages: Red blood cells which would have been lost are
scavenged and re-infused. The technique provides a supply of
red blood cells in proportion to the losses. This provides a
means of reducing the requirement of allogenic blood trans-
fusion.
Disadvantages: Intraoperative cell salvage requires complex
specialized instrument and a high level of training for the
operator. The process is complex and can result in serious
complications.
Preoperative Autologous Donation (PAD)
• This process commences up to 5 weeks prior to surgery
(defined by the limit of conventional blood storage techniques)
allowing the collection of up to 4–6 units of blood. Oral or
IV iron supplementation (for faster increase in haemoglobin)
may be required to maintain erythropoiesis.
• The last donation should take place at least 48–72 hours
before the surgery to allow equilibration of blood volume.
• The blood is collected into blood bags and stored in the blood
bank in a conventional manner. It should be clearly labeled
to identify it from allogenic units.

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Essentials of Blood Banking and Transfusion Medicine
• At the time of surgery, the pre-donated blood is issued from
the blood bank as required in the conventional manner.
Criteria for Autologous Donation
• Hb: 11 gm/dL or haematocrit 33% or higher.
• Age: No upper or lower limit.
• Weight: Blood drawn is adjusted using the formula. Anti-
coagulant added also needs to be adjusted.
• Frequency of donation: Not less than every 3 days and not
less than 72 hours before surgery.
In certain occasions “Frog Leap” technique can be used to
collect autologous blood which needs close observation by the
physician and blood bank staff. With this procedure on day 36,
about 6 units of blood can be kept ready before surgery.
Phlebotomy day Units drawn Units re-infused Number of units available
Day 1
1
None
1
Day 8
2
1
2
Day 15
4
2
3
Day 22
6
3
4
After 28 days
8
4
5
Day 36
10
5
6
Advantages
• The technique provides up to 4–6 units of blood, which will
cover many elective operations and eliminate the need of
blood from other donors. The risks of viral transmission and
immunologically mediated haemolytic, febrile or allergic
reaction are virtually eliminated provided the patient only
receives autologous blood. Immune-modulation seen after
allogenic transfusion does not occur.
• Autologous blood transfusion, when used appropriately, can
provide a safe alternative to allogenic blood transfusion.
However, there will always be a need for allogenic blood
(even patients who have autologous blood, may need further
transfusion with allogenic units).

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Disadvantages
• The system requires a great deal of logistic planning well
ahead of surgery. This may be a particular problem where
surgery is re-scheduled at short notice. Pre-donated blood
must be clearly labeled in the blood bank and the risk of
clerical or human error remains. Up to 50% of pre-donated
blood is unused; this wastage together with costs of
administering PAD results in higher cost per unit of blood
in comparison with allogenic blood.
Acute Normovolaemic Haemodilution (ANH)
• The blood collected just prior to surgery is re-transfused after
surgery. This procedure can replace allogenic blood trans-
fusion, increase the level of anaemia tolerance and adapta-
tion to volume and red cell loss. ANH in cardiac surgery
can reduce blood viscosity during hypothermia. Not only
in adults, elderly, neonates and children but also in all types
of surgeries like orthopaedic, gynaecological, urological and
vascular surgeries, ANH can be beneficial.
• Relative contraindications are in patient of unstable angina
pectoris, severe coronary artery stenosis, CCF, COPD, etc.
Blood collection is usually done after induction of anaesthesia
and before surgical blood loss occurs. The blood must be
labeled with patients’ name, identification no. and time of
withdrawal. It is stored at room temperature in the operation
room and should be infused at the end of the surgery or
infuse earlier if signs of hypoxia occur. The blood withdrawn
is replaced by crystalloids and colloids. Thus, there is mainte-
nance of normovolaemia.