Autotransfusion and Its Impacts

Blood transfusion is a safe medical procedure, as considered by many. Still, the American Medical Association and the Joint Commission claim that it is one of the five most overused medicine therapies.  Research indicates that up to 60% of blood transfusions are either ineffective or, at best, not demonstrably effective. Moreover, blood transfusions have been correlated with higher mortality and morbidity rates, increased length of stay, readjustments, hospital-acquired infections, and other complications.

In addition to elevated health risks, the adverse effects of transfusion jeopardize reimbursements and raise treatment costs for both patients and providers. So, aside from providing transfusion only when required, what can providers do to reduce the risk of complications and operate more cost-effectively in this area?

The reality is that autotransfusion — the method of using a patient’s blood for transfusion — can safely substitute the practice of using donated blood transfusions in many instances.

What is Autotransfusion?

Autotransfusion is a procedure in which a person receives his or her own blood for a transfusion instead of separate-donor blood. There are two primary forms of autotransfusion: 

1. Blood can be autologously “pre-donated” (i.e., despite “donation” that does not generally apply to self-giving) before surgery. 
2. Blood can be obtained during and after surgery using an intraoperative blood rescue system (e.g., Cell Saver, HemoClear, or CATS). 

The second autotransfusion method used in procedures where a significant amount of blood is required – e.g., aneurysm, complete joint replacement, and spinal surgery. The intraoperative blood rescue system provides excellent efficiency, protection, and cost savings in people undergoing thoracic or abdominal surgery following trauma. Autotransfusion also refers to the normal mechanism in which (during fetal delivery) the uterus naturally contracts and the blood returns to the maternal circulation. This is important in pregnancy since the uterus (at later stages of fetal development) can contain up to 16% of the mother’s blood supply.

Process of Autotransfusion

There are various ways of autotransfusion with different procedures in the operating room and the emergency room. Autotransfusion’s goal remains the same for maintaining a sterile area, preventing blood clotting, blood filtration, and administration to the patient. The procedure does not take longer than a few minutes to plan and have a common purpose as an alternative or transitional alternative treatment. It is essential to familiarize oneself with the equipment available at the treatment facility to minimize the chances of infection and other complications.

Steps to Follow During An Autotransfusion:

• Place a pericardial drain or 8F or 9F sheath into the pericardium.
• Place the 5F–8F sheath in the femoral vein (or already placed as a “bailout” at the start of the procedure). Alternatively, use a large-bore sheath in the neck.

• Link the drain to the sheath with a stopcock and a male-to-male tubing (or a suitable adapter when male-to – female tubing)
• Aspirate blood from the drain with a large syringe, and then push it back into the venous system.

Do this for a few minutes until the pericardium is dry, preventing leakage by sealing the perforation. Never reintroduce blood to the left atrium (i.e., via the delivery sheath) or the arterial system.

Positive Impacts of Autotransfusion

• High levels of 2,3-DPG
• Normothermic
• pH relatively normal
• Lower risk of infectious diseases
• Functionally superior cells
• Lower potassium (compared to stored blood)
• Quickly available
• May reduce the need for allogeneic red cell transfusion during certain surgeries, such as adult elective cardiac and orthopedic surgery.
• Eliminates the risk of transmission of infectious diseases (hepatitis, malaria, lues, AIDS, etc.)
• There is no chance of is sensitization
• Autologous blood guarantees improved oxygen transfer and increased coagulation activity
• Eliminated pre-transfusion checks
• Removed moral concerns to transfusion of homologous blood.
• Blood shortage does not delay the surgery.

Substances that Wash Out During Autotransfusion

• Plasma
• Platelets
• White cells
• Anticoagulant solution
• Plasma free hemoglobin
• Cellular stroma
• Activated clotting factors
• Intracellular enzymes
• Potassium
• Plasma bound antibiotics

Negative Impacts of Autotransfusion.

Generally, preoperative autologous donation reduces (but does not eliminate) the risks of allogeneic blood transfusion. While accepted by patients and many surgeons, the preoperative autologous donation may affect by unexpected disadvantages. These disadvantages include the inconvenience of the patient and the cost of handling the blood. This leads to the discarding of up to one-third of the blood collected units. Patients are often anemic at the time of surgery, raising the risk that transfusion. Although these patients may have been transfused with their blood, there is still a risk. A clerical error and pre-donated blood are among the most common causes of hemolytic transfusion reactions. Changes in blood during storage can make patients susceptible to complications, such as TRALI, even if they have blood transfusions.

Some complications arise from autotransfusion. The most common complication of autotransfusion is the loss of blood if not linked correctly. A typical finding is the positioning of a chest tube to express blood and then waste it. The more severe complication involves contamination of the blood resulting from infection. This problem may be prevented by a sterile method for positioning the chest tube and properly handling the lines and equipment. Other less common complications that need consideration include hemodilution, hemolysis due to suction, air embolism, contaminated activated leukocytes, and thrombocytopenia. Overall, doctors can prevent complications by using a sterile procedure, and by infusing less than 3000 mL of blood.

Is Autotransfusion A Better Solution than Donated Blood Transfusion?

Doctors should use a method like autotransfusion for any trauma patient in the emergency department. They can also use it in patients undergoing surgery or any patient with expected blood loss without contraindications. It benefits the patient from a decreased risk of transfusion reactions as well as potential cost-saving benefits. Autotransfusion may be used in combination with cross-matched blood, which may help provide a time-limiting step when awaiting cross-matched blood delivery. Setup is relatively straightforward and does not require any substantial additional time or resources.

In the end, the practice of autotransfusion offers a simple solution when blood is needed quickly. In only three to five minutes, the patient’s red blood cells will be returned to him or her. With an unlikely immune response, reduced risk of infection, reduced morbidity, probably lower length of stay, and no need for blood bank reserves, patients may enjoy potentially substantial cost savings and, most significantly, improved outcomes. Research is clear: autotransfusion is a much safer and economically sound substitute for donated blood transfusions, making it a smart investment for healthcare providers.