Cardiac and vascular surgery
The use of autologous blood during cardiac surgery and open aortic surgery is widely accepted. Routine use reduced the transfusion of red cells by 40% / 37% respectively. After bypass, around 500 –1000 ml of blood will be left in the bypass circuit and reservoir, processing this blood volume reduces the requirement for allogeneic blood. The use of autologous blood, at least in ‘collect only’ mode, is recommended for all cardiac and vascular surgery.
Orthopaedics
Autologous blood transfusion is helpful if a tourniquet, such as hip arthroplasty or spinal surgery, cannot be applied. When tourniquets are used, autologous blood transfusion can be used once the tourniquet has been released. Blood collected postoperatively can be re-infused. The surgical field is likely to be contaminated with antibiotics, iodine, or topical clotting agents; autologous blood may be used once these contaminations have been washed away.
Obstetrics
Hemorrhage associated with operative delivery is often not predictable, rapid, and occurs out of hours. Presumed risks for autologous blood use are amniotic fluid embolism and, maternal alloimmunisation. Levels of fetal squamous cells in the use of autologous blood are comparable to those in maternal venous blood at the time of placental separation. No definite cases of amniotic fluid embolism have been reported. The use of swab washing to improve collection rates should be considered.
Trauma
In abdominal or thoracic trauma surgery patients the use of autologous blood resulted in the transfusion of 4.7 fewer units of donor red cells. In patients undergoing pelvic acetabular fracture fixation, only 47% of patients required allogeneic transfusion. In a combat hospital, autologous blood transfusion is most successful in patients with gunshot wounds and cavity injuries. In a dedicated trauma/emergency operating theatre, it’s recommended that autologous blood is immediately available at all times.
Paediatrics
Autologous blood is used most frequently in spinal surgery (larger children or adolescents), during cardiac surgery, liver transplantation, and craniofacial surgery. Autologous blood transfusion should be considered at least in ‘collect only’ mode when blood loss > 8 ml.kg−1 (equivalent to approximately > 10% of total blood volume) is anticipated and the child’s weight is > 10 kg. In many cases, the volume retrieved is insufficient to be processed by centrifugal devices but micro-filtration doesn’t have a minimum volume requirement.
Postoperative
Patients may bleed postoperatively, and drains prevent the accumulation of blood. Blood collected via drains can potentially be re-infused. Postoperative cell salvage after cardiac and orthopedic surgery showed a 41% reduction in donor red cell transfusion. Re-infusion without washing, after orthopedic procedures is safe. After cardiac surgery, blood collected via the chest drains must be processed through a cell salvage system before re-infusion.
Cancer surgery
Despite theoretical risks, there is no conclusive evidence that the use of autologous blood can induce metastases. The theoretical risk of inducing metastatic spread is offset by reduced allogeneic transfusion and immunomodulation, which is proven. Many clinicians do offer autologous blood to patients undergoing major cancer surgery. Malignant cells can be reduced by the use of Leucodeplation filters in the transfusion line, with no apparent adverse effect on the quality of the product.
Infected and contaminated fields
Autologous blood theoretically worsens sepsis by infective agents recovered in the operative field. Conversely, the use of autologous blood reduces allogeneic blood, which may increase postoperative infection by immunomodulation. Washing of collected blood and the use of Leucodeplation filters in the transfusion line removes most bacteria. There is no conclusive evidence that autologous blood worsens sepsis, even when used in contaminated fields, including major trauma surgery.