intra operative blood conservation
DESCRIPTION
Intra operative blood conservation. Intra operative blood conservation. Advantages of autologous blood. Intra operative blood conservation. AUTOLOGUS BLOOD TRANFUSION. Comparison. Intra operative blood conservation. AUTOLOGUS BLOOD TRANFUSION. Autologus Transfusion - PowerPoint PPT PresentationTRANSCRIPT
Advantages of autologous blood
Prevents transfusion-transmitted diseasePrevents red cell alloimmunization
Supplements the blood supply
Provides compatible blood for patients with alloantibodiesPrevents some adverse transfusion reactionsProvides reassurance to patients concerned about blood risks
AUTOLOGUS BLOOD
TRANFUSION
ComparisonAUTOLOGUS BLOOD TRANFUSI
ON Parameter
Autologus blood
35 (Whole Blood)
pH 7.55 6.73
Plasma hemoglobin (mg/dL)
0.5 46
Plasma potassium (mEq/L)
4.2 17.2
Plasma sodium (mEq/L)
169 153
Blood dextrose (mg/dL)
440 282
2,3-Diphosphoglycerate (µM/mL)
13.2 1
Percent survival — 79
Autologus Transfusion
•PAD/SFDN-Pre op autologus donation.
•ANH-Acute normovolumic hemodilution
•ICS-Intra operative cell salvage
AUTOLOGUS BLOOD TRANFUSI
ONTYPES
•The technique of collecting and reinfusing blood lost by a patient during surgery.
Intra operative cell salvage
ICS Intra op
cell salvage
ICS Intra op
cell salvage
•Management of severe, rapid blood loss •Reported in 1917•Started as life saving procedure than regular.•Most cases were hemothorax & turp•1970-Bently autotranfusion system•1974-Hemonetics cell saver
HISTORY
Three general types of salvage procedures:
1.Cell processors and salvage devices that wash and save red blood cells, i.e., "cell washers" or RBC-savers 2.Direct transfusion 3.Ultrafiltration of whole blood
Blood salvage proceduresTYPES
Method
Cell processor
Method
Cell processor
1.COLLECTION
•Using a dual lumen tube, anticoagulant is fed to the operation site to be mixed immediately with shed blood and sucked away.
•The choice of anticoagulant either Heparin or Citrate.
Method
•Blood and anticoagulant are carried into a sterile reservoir by vacumm.
•It is filtered to remove large clots and debris.
•Most collection reservoirs have a filter in the 40-150 micron range.
•Between 1:5 and 1:10 ratio of anticoagulant to collected blood.
2.STORAGE
Method
Blood and anticoagulant are drawn from the collection pot into a centrifuge to be processed.
The force supplied by the centrifuge holds the more dense red blood cells against the outer wall of the bowl. The less dense white blood cells, platelets, plasma and anticoagulant move towards the centre of the bowl where they spill over into a waste bag
3.CENTRIFUGEMethod
Blood is washed with a saline solution and red blood cells are separated from waste products.A sterile isotonic saline solution is pumped into the centrifuge bowl. Only a 0.9% sterile normal saline is recommended.
4.washingMethod
Waste products include white blood cells, platelets, plasma, anticoagulant, fat and free plasma haemoglobin. These are collected in a bag.
5.Waste separationMethod
Packed red blood cells are separated from waste products and collected in a separate bag
6.Processed RBC
Method
Red blood cells can then be reinfused immediately or taken to recovery or the Ward to be reinfused later. There is, however, a limit of 6 hours during which reinfusion can take place.
7.Reinfusion
Method
CELL SAVER
DEVICES
Practical consideration
s
1. If not transfused immediately, units collected from a
sterile operating field and processed with a device for intraoperative blood collection that washes with 0.9% saline, USP, shall be stored under one of the following conditions prior to initiation of transfusion:
At room temperature for up to 4 hours after terminating collection;
At 1–6° C for up to 24 hours, provided that storage at 1–6° C is begun within 4 hours of ending the collection.
2. Transfusion of blood collected intraoperatively by other means shall begin within 6 hours of initiating the collection
3. Each unit collected intraoperatively shall be labeled with
the patient's first name, last name, and hospital identification number; the date and time of initiation of collection and of expiration; and the statement "For Autologous Use Only."
4. If stored in the blood bank, the unit shall be handled like
any other autologous unit.
•Hemofiltration or ultrafiltration devices filter the patient's anticoagulated whole blood. •The filter process removes unwanted excess non-cellular plasma water, low molecular weight solutes, platelet inhibitors, and some particulate matter including activated cytokines, anaphylatoxins, and other waste substances through hemoconcentration; thus making concentrated whole blood available for reinfusion.• Hemofilter devices return the patient's whole blood with all the blood elements and fractions including platelets, clotting factors, and plasma proteins with a substantial Hb level.
Ultrafiltration of Whole
Blood
Ultrafiltration
Ultrafiltration of Whole
Blood
Ultrafiltration
These devices do not totally remove potentially harmful contaminants that can be washed away by most RBC-savers
That coagulation and homeostasis are immediately improved with the return of concentrated autologous whole blood
Direct transfusion is a blood salvaging method associated with cardiopulmonary bypass (CPB) circuits or other extracorporeal circuits (ECC).
Following bypass surgery the ECC circuit contains a significant volume of diluted whole blood that can be harvested in transfer bags and re-infused into patients. Residual CPB blood is fairly dilute ([Hb] = 6–9 g/dL) and can also contain potentially harmful contaminants such as activated cytokines, anaphylatoxins, and other waste substances
Direct transfusion DIRECT
TRANFUSION
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