Autotransfusion Shed blood from a surgical field is
Autotransfusion • Shed blood from a surgical field is collected, packed and washed before re-infusion to the patient • In simple term: “ Recycling of shed blood from an operating field ”
Clinical applications include any procedure where blood loss is anticipated to be at least one liter • • Cardiac surgery Thoracic and Vascular surgery Trauma applications Neurosurgery Orthopedic surgery General surgery Transplantation
Why Autotransfusion? • Immediate availability • Reduced risk of infection or viral transmission • Negates the immune phenomenon • Eliminate giving wrong blood type due to human error • Conserves bank blood for real emergencies • Reduced supply of bank blood
Method 1. PABD (Preop. Autologous blood donation)(수술 전 공혈) 2. ANH (acute normovolemic hemodilution) (급성 동량성 혈액희석법) 3. Intraoperative blood recovery (수술 중 혈액 회수법) = Cell Saver 4. Postoperative blood recovery (수술 후 혈액 회수법) = sure-trans
Washed versus Unwashed • Once in the body these can cause: - Fat embolism syndrome - Adult respiratory distress syndrome (ARDS) - Disseminated intravascular coagulopathy (DIC) - Acute renal insufficiengy → A good quality wash reduces these risks
Autotransfusion system 1. Discotinuous system - bowl system 2. Continuous system - CATS (continuous autotransfusion system)
Bowl system • - Haemonetics: Cell Saver (conical) Hemo. Lite (blow molded) Ortho. PAT (dynamic disc) • Electromedics/Medtronic: - Elmd/sequestra (conical) - Autolog (blow molded) • - Sorin/Dideco/Cobe: Compact A (conical) BRAT 2 (cylindrical) Selecta (conical)
Device components
Device components
Processing phase
C. A. T. S system: device components
Double spiral washing chamber
Principle of separation chamber
Autologous transfusion and blood-sparing techniques in infants and children Small infants or neonates certainly will not tolerate a blood loss of 300 ml without receiving homologous blood. CATS allows the effective processing of shed blood, even if less than 100 ml are available. (Curr Opin Anaesthesiol. 2000; 13: 303 -6)
Fat embolism & autologous blood transfusions in orthopaedic surgery • Shed blood may contain high concentrations of inflammatory mediators and may be contaminated with fat particles which may increase the risk of fat embolism. • Transfusion of blood after washing and centrifugation and filtration of salvaged blood are available methods for transfusion of shed blood and that may reduce the amount of transfusion of fat. (Current Anaesthesia & Critical Care 2004)
Fat elimination during intraoperative autotransfusion: an in vitro investigation l Method: Two units (CS 5 & CATS) l Results: Device Cell Saver 5 Fat retention 30. 3 ± 7. 8 ml C. A. T. S 0 ml l Conclusion: “The availability of fat-free WPRBC from the new generation of autotransfusion devices should eliminate the risk of retransfusion of non-emulsified fat and may be a step towards improved patient safety, especially in orthopedic patients (Anesth Analg. 1997 Nov; 85(5): 959 -62)
Bacterial reduction by cell salvage washing and leukocyte depletion filtration • Expired packed erythrocytes were obtained and inoculated with a fixed amount of a stock bacteria in amounts ranging from 2, 000 to 4, 000 colony forming units/ml. • The blood was processed via a cell salvage machine. • The washed blood was then filtered using a leukocyte reduction filter.
Bacterial reduction by cell salvage washing and leukocyte depletion filtration • From the prewash sample to the postfiltration sample, 99. 0%, 99. 6%, 100%, 97. 6% of E. coli, S. aureus, P. aeruginosa, and B. fragilis were removed, respectively. (Anesthesiology 2003; 99: 652 -5)
Facilities for blood salvage (cell saver technique) must be available in every obstetric theatre • The use of a Leuko. Guard RS filter that reduces amniotic fluid contamination makes ICS a safe option both to provide a readily available blood supply and to minimise use of precious allogeneic stores. (Int J Obstet Anesth. 2005; 14: 48 -50)
The Fresenius continuous autotransfusion system (CATS): preliminary studies and application • A new CFC apparatus for intraoperative blood salvage (CATS) has been introduced by Fresenius and submitted to preliminary evaluation at our hemaphresis unit. • The vol. of shed blood submitted to washing was 1714 ± 496 with a hematocrit of 19% and the vol. of PRBC ready for transfusion 297. 9 ml with hematocrit of 64. 3%.
The Fresenius continuous autotransfusion system (CATS): preliminary studies and application • Elimination of contaminant activated platelets and WBC was 92% and 74% respectively. • Elimination of contaminants such as protein, free hemoglobin, LDH and K ions was always over 95%. • Regular application of CATS is warranted after our study. (Int J Artif Organs. 1996; 19: 431 -4)
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