Autotransfusion

Overview of Autotransfusion

Accidents are the main cause of death for people up to 44 years old. In 2018, about 1.2 million people worldwide died because of road accidents. With the world’s population growing rapidly and industrialization increasing, it’s expected that the death rate from road accidents will rise by 67%.

Bleeding heavily, or exsanguination, often plays a significant role in accident-related deaths. For patients who arrive at the hospital with accident injuries, bleeding is the main cause of death within the first hour. In fact, nearly 50% of all deaths within the first 24 hours are due to bleeding.

Worldwide, heavy bleeding is the main cause of death that could’ve been prevented in both traumatic injuries and childbirth. These deaths could be avoided if the bleeding is stopped and the lost blood is replaced through a transfusion. Blood transfusions save millions of lives each year.

However, accident victims need a lot of hospital resources, including blood for transfusions. About 70% of all blood transfused at a hospital that treats accident victims comes from these patients. Blood transfusions also account for a large part of the treatment cost. In England, a study found that about 12% of all their treatment cost was due to blood transfusions in accident victims.

Although using donated blood that’s been tested for compatibility is the usual treatment for patients who’ve lost a lot of blood, it’s not without risk. Side effects can include disease transmission, being too acidic, low blood calcium and magnesium, being too cold, potential for infection, respiratory failure, and blood clot complications. Because of these risks, autotransfusion, or reusing your own blood, is sometimes used instead of, or along with, a transfusion with someone else’s blood. Autotransfusion is generally considered safer.

However, autotransfusion wasn’t always safe. The first known time it was done was in 1818 by Dr. James Blundell. He was a doctor who got frustrated when one of his patients died from heavy bleeding after a childbirth. Although he was the first to try autotransfusion, it was a risky procedure. About 75% of his patients died from it. Today, because of modern improvements in cleaning the blood and sterile techniques, autotransfusion is a much safer procedure.

Why do People Need Autotransfusion

Autotransfusion, which is a procedure where your lost blood is collected, cleaned, and given back to you, is ideal for people who have lost a significant amount of blood. This usually applies to situations where more than a liter of blood has been lost. Autotransfusion can be used in emergency situations where there is an urgent need for blood, or when suitable matched blood isn’t readily available. It’s also a good option for patients who refuse to accept blood from other people for personal reasons.

The type of autotransfusion procedure used can depend on the resources at hand. In medical institutions with plenty of resources, sophisticated autotransfusion systems are used. This is often employed for non-urgent surgeries like those related to the heart, blood vessels, and bones. In these cases, the blood is safely kept in a controlled area where it does not come in contact with the outside air.

Conversely, in places with limited resources, a simpler autotransfusion procedure is used, typically during emergency surgeries. For instance, this might be used during the operation for a ruptured ectopic pregnancy, which is a life-threatening condition where a pregnancy develops outside the uterus. This simpler version of autotransfusion does expose the blood to air, but it’s considered a life-saving fallback option when no other choices are available.

Autotransfusion could be indicated for the following situations:

* Ruptured ectopic pregnancy (a life-threatening condition where a pregnancy develops outside the uterus)
* Ectopic pregnancy (a pregnancy that is not in the uterus)
* Hemothorax (blood in the space between the chest wall and the lung)
* Vaginal postpartum hemorrhage (bleeding from the vagina after childbirth)
* Abdominal trauma and ruptured ectopic pregnancy
* Blood from the peritoneal cavity (the space within the abdomen that contains the intestines, stomach, and liver)
* Ruptured uterus (a tear in the wall of the uterus, most often during labor)
* Maternal hemorrhage (severe bleeding in a mother during or after childbirth)
* Thyroid surgery

When a Person Should Avoid Autotransfusion

While it’s usually clear when someone might need a blood transfusion using their own blood, known as an autotransfusion, there are many reasons why this might not be a good idea. If ignored, these reasons could lead to serious problems. Firstly, it’s crucial to check whether the blood could possibly be contaminated. Contamination could be either infectious, from sources such as a penetrating chest wound that has damaged the digestive system, or noninfectious, where the blood might have mixed with a sterilization solution like iodine.

The wound should be carefully inspected before using the blood that’s been collected. If there’s any doubt about its cleanliness, it would be safer to use blood that has been cross-matched. Another contamination risk could be non-infectious, where a sterilization solution might have mixed with the blood. This includes iodine, sterile water, alcohol, irrigation fluids, or chlorhexidine, and should be avoided.

Also, it’s important to note that we should not collect blood exposed to hemostatic agents like thrombin, which help stop bleeding. If someone has a blood clotting disorder, known as coagulopathy, or a condition that causes blood clots to form throughout the body (disseminated intravascular coagulopathy or DIC), they would need a different type of treatment rather than an autotransfusion.

Some other people who might not be good candidates for autotransfusion are those with sickle cell disease or women who have just had a cesarean section. More research is needed to understand these situations better.

Here are the main reasons why someone might not be able to have an autotransfusion:

• Septicemia, a severe infection in the bloodstream
• If the blood contains cancer cells
• If the person’s kidneys or liver are not working properly
• Coagulopathies, or blood clotting disorders
• If the blood has been sitting in the collection system for longer than the hospital’s rules allow

However, if the patient is in a critical situation with severe blood loss and there is not enough suitable blood available from the blood bank, these reasons might be overlooked and autotransfusion might be carried out regardless of these risks.

Equipment used for Autotransfusion

Autotransfusion systems are used to collect and transfuse a patient’s own blood during a surgical procedure. There are three main types of these systems: in-line, self-filling, and continuous. In the in-line system, a blood bag collects the fluid for later use. In the self-filling system, a vacuum is used to enhance the flow of fluid into the bag. The continuous system, on the other hand, employs an infusion pump and filter to directly transfer the blood into the patient’s veins. This last system is faster, requires less staff interaction, and poses less risk of contamination. Although this method is commonly used in the operating room, many emergency departments don’t have it available and instead use the in-line technique.

These systems are made by various manufacturers. What’s available may vary between hospitals; further, specific products may require staff to undergo product-specific training.

To perform in-line autotransfusion, surgeons need specific equipment, including: a sterile gown and gloves, a face mask with a shield, a hairnet or cap, some iodine or chlorhexidine to clean the patient’s exposed skin, a blood collecting bag, a very fine microaggregate filter, a liter of sterile normal saline (a saltwater solution), an IV start kit with extension tubing, a pressure bag, a substance like citrate or heparin to prevent blood clotting, a chest tube drainage kit with water seal, and a tube thoracostomy kit (used to insert a chest tube).

Generally, the following equipment is required for an autotransfusion procedure: personal protective gear (like gloves, mask, and eyeshield), a unit to drain the chest, an autotransfusion collection system, a set to administer the blood, a very fine 40- μ m microemboli filter, some normal saline, and a wall suction and regulator.

Preparing for Autotransfusion

Autotransfusion is a technique often used in emergency departments for trauma patients who have a significant amount of blood collecting in their chest cavity, a condition known as hemothorax. It’s an immediate process that begins before the chest tube is even inserted to drain the blood. If an autotransfusion bag is not ready when the chest tube is inserted, too much blood might be lost, making autotransfusion no longer a feasible option.

Strict cleanliness is critical during this process to prevent infections; doctors wear sterile gloves, a face mask with an eye shield, and a cap. The patient’s skin is cleaned with iodine or chlorhexidine solution, and a sterile drape is used.

The first action in this process is to connect the autotransfusion bag to the chest drain. An anticoagulant solution — a medicine that prevents blood from clotting — must be used; this solution is either heparin or citrate. Both of these stop the blood from clotting while it is being collected in the bag. While heparin needs to be mixed with a solution called normal saline before adding to the blood, citrate can be mixed directly with the collected blood. Heparin does have an added risk of causing a condition called heparin-induced thrombocytopenia. As a result, many doctors prefer using citrate over heparin.

If using heparin, it is mixed into a solution with normal saline. This solution is added to the collection bag before any blood is collected and repeated each time the bag is used. During the collection, this anti-clotting solution runs at a certain rate per volume of collected blood. Once approximately 500 mL of blood has been gathered, it is ready to be returned to the patient’s body.

In contrast, if citrate is used, it is added straight to the collected blood. A common method is to put 60 mL of citrate into the autotransfusion bag before collecting the blood, and stopping the collection when the bag reaches 500 mL.

A microfilter must be attached to the tubing to filter out any potential clots or debris, and air must be removed from the bag. A new filter and tubing must be used each time. The collected blood can be stored at room temperature for up to six hours if needed, as long as it is collected under sterile conditions.

Before the process, healthcare providers should make sure the patient or their caregiver understands the procedure. In non-emergency situations, all questions should be answered, and the necessary information reinforced as needed.

How is Autotransfusion performed

Autotransfusion is a procedure where we reuse your own blood during an operation or in an emergency room setting. The aim is to collect the blood that’s lost inside your body, clean it, and then transfuse it back into your bloodstream. It helps to maintain sterile conditions, prevent clotting, and filter the blood. The procedure doesn’t take a lot of time to set up and is used as an alternative or standby for other treatments. It is important to know the equipment and procedure well to decrease the chances of infection and other complications.

Here is a simplified step-by-step guide:

1. Setup the collection system.
2. Add a blood thinner into the bag where we will put your collected blood to stop it from forming clots. This could change depending on the hospital’s rules.
3. Link the bag with the tube that is draining your lost blood.
4. Prepare a new bag before removing the filled bag.
5. Close the clip on the new bag.
6. Close the clip on the drainage tube attached to your body.
7. Carefully take off the filled bag from your system while making sure everything stays clean.
8. Attach the new bag to the water-sealed system or your drainage tube.
9. Make sure all links are secure and open the clips on your drainage tube and the bag.
10. Prepare the blood-transfusion tube system with a normal salt solution.

After that, attach a tiny filter to the blood part of the tube and connect the filled bag. Begin putting the cleaned blood back into you. Repeat this as needed depending on how you’re doing after the first one. Then we discard supplies and equipment and take off protective clothing that we wore during the procedure.

Possible Complications of Autotransfusion

Autotransfusion, a procedure in which a patient’s own blood is transfused back to them, can sometimes come with complications if not performed correctly. The most common issue is blood loss, which can happen if the equipment used isn’t connected properly. One typical sign of this is blood being lost through a chest tube, instead of being reused.

A more serious issue could be contamination of the patient’s blood, which could lead to infection. This risk can be reduced by making sure the chest tube is placed using a clean, sterile method, and by carefully monitoring and handling any equipment and tubing used in the procedure.

In some cases, an automatic autotransfusion system can be used to further lower this risk, although these systems are not commonly available in most hospital emergency departments.

There are also other, less common issues that could happen, including watered-down blood (hemodilutio), breaking down of red blood cells (hemolysis), air getting into the bloodstream (air embolism), contamination of white blood cells (leukocytes), and low platelet counts (thrombocytopenia). It’s important to note that most issues can be avoided by maintaining clean, sterile conditions during the procedure and by ensuring that no more than 3000 mL of blood is transfused back into the patient.

What Else Should I Know About Autotransfusion?

Autotransfusion is a technique that we, in the medical field, often consider using in trauma patients. Essentially, it’s a process where a patient’s own blood is used for transfusion, rather than someone else’s. This can be a great help in the emergency department when a patient is losing a substantial amount of blood. It can also be used during surgeries where blood loss is expected.

One of the major advantages of autotransfusion is that it reduces the risk of reactions to a blood transfusion, which can happen when blood from another person is used. It can also be a cost-effective choice. In some situations, autotransfusion can also be used alongside cross-matched blood, which is blood that has been tested to make sure it’s compatible with the patient’s. This can be particularly helpful when we’re waiting for matched blood to be available for use.

From a practical standpoint, setting up for autotransfusion isn’t overly complicated or time-consuming, and it doesn’t require a lot of additional resources. So while the decision of whether to use autotransfusion is based on several factors, including a patient’s specific situation, it’s definitely something that we often consider when a patient is losing blood quickly.