Chapter 66. Autologous Transfusion

• Donation is made by intended recipient
• Safest blood—no exposure to foreign alloantigens or transfusion-transmissible viral infections
• Can avoid the formation of red cell, white cell, or HLA antibodies
• Useful especially if patient has rare blood type or multiple alloantibodies
• Four broad classifications of autologous donation:
  • Preoperative donation
  • Perioperative hemodilution (acute normovolemic hemodilution [ANH])
  • Intraoperative collection (AKA Cell Saver)
  • Postoperative salvage

Factors to determine whether a patient should undergo preoperative autologous donation (PAD):

• Date of surgery:
  • Generally the patient donates 1 U per week, as long as predonation Hgb and Hct remain >11 g/dL and ≥33%, respectively
  • Minimum of 3 days between collections
  • Minimal allowable time between the last donation and surgery is 72 hours to allow for volume repletion
• Expected surgical blood loss
• Patient’s hemoglobin and hematocrit
• Availability of blood supply (rare groups, antibodies)
• Religious beliefs (some Jehovah’s Witnesses will accept autologous blood; others will accept hemodilution only if continuity maintained with the IV collection bag)
• Acceptable peripheral venous access
• Existence of underlying conditions that could be worsened by donating or that would preclude donation

The technique that should be used in order to avoid or decrease the chance of receiving allogeneic blood should be discussed in advance with the patient, and the risks and benefits of each addressed.

Indication

• Often ordered for use in elective surgeries such as orthopedic, selected gynecologic, and cardiovascular or prostate surgeries
• Major indication—anticipation that at least 1 U of blood will be needed intraoperatively or postoperatively

Method

• Hemoglobin ≥11 g/dL
• Give PO iron for 3 weeks, can also be supplemented with recombinant EPO 40,000 U SQ q7 days
• PAD accomplished by whole blood phlebotomy or red cell apheresis
• Frequency of donation—no more than q3 days and not less than 72 hours before scheduled surgery
• Administer units in chronological order

Risks

• Iatrogenic anemia resulting after donation
• Iatrogenic hypovolemia after donation
• Some underlying medical conditions may be worsened by donating blood
• Same adverse reactions that can occur with allogeneic whole blood or apheresis donation
• Risk of bacterial contamination if inadequate skin prep or if patient is bacteremic
• Clerical error leading to transfusion of another unit of blood

Benefits

• Age: no upper or lower limit
• Parental/guardian consent for patients under 17 years of age
• Weight—no minimum weight
• If <50 kg, adjust amount of blood removed
• If <300 mL, adjust amount of anticoagulant
• Conserve nontransfused units for postoperative period
• Patients with chronic viral infections or risks associated with nonbacterial infections (hepatitis or HIV) are eligible to donate in many situations

Contraindications

• Preexisting conditions: symptomatic CAD, CHF, MI within past 6 months, and/or medication(s) for cardiovascular disease emphysema, or COPD
• Uncontrolled HTN, known cerebrovascular disease (including CVA within 6 months), and AS
• Presence or evidence of ...