Recent work on contamination involving cell salvage systems incorporates a cell-washing step. 45 An early study of autotransfusion before cell washing was implemented found that despite reinfusion of massively contaminated blood, 17 of 25 patients survived without evidence of septic complications. 44 Concerns regarding gross contamination from concomitant gastrointestinal tract injury have also been disputed. However, recent work using perioperative cell salvage suggests that the risk for dissemination of malignant disease is minimal. 43 With direct autotransfusion of pleural blood through a microfilter, the risk of reinfusing tumor cells is unknown. 8, 42 Others include active infection, gross contamination, and the possibility of malignant cells in the salvaged blood. Coagulopathy and disseminated intravascular coagulation (DIC) are important contraindications. In some situations emergency autotransfusion may pose more risk than benefit. 35 Box 27-1 summarizes the advantages of autotransfusion. 32– 34 Adias and colleagues compared the direct cost of banked blood with the cost of autologous blood transfusion and found substantial savings with autotransfusion. 31Īutologous blood provides societal benefits by preserving the limited stores of banked blood and reducing the cost of medical care.
28– 30 In patients whose religious convictions (e.g., Jehovah’s Witness) prohibit transfusions with homologous blood, reinfusion of autologous blood that does not involve blood storage may be an acceptable alternative. 24 In trauma patients, allogeneic transfusions have been shown to be an independent risk factor for infection, 25– 28 which may be dose dependent and independently associated with increased morbidity and mortality. 23 Immunologic transfusion reactions and posttransfusion sepsis continue to be risks as well. 21, 22 Although the risk for transfusion transmissible diseases has decreased dramatically in developed countries, it is still very problematic worldwide. There are numerous transfusion transmissible diseases, including viruses such as human immunodeficiency virus and hepatitis, bacteria, parasites, and most recently reported, variant Creutzfeldt-Jakob disease. The blood is normothermic and compatible, which avoids the risk of allergic reaction or infection from transfusion transmissible diseases. Shed blood from traumatic hemothorax is immediately available for rapid transfusion. 14– 17 This revitalized interest, coupled with increased experience in surgical, trauma, and combat situations, has thus initiated a new era in autotransfusion. During the 1960s and 1970s, cardiopulmonary bypass surgery and combat trauma experience during the Vietnam War generated extensive data regarding intraoperative retrieval of large quantities of blood for reinfusion. The discovery of ABO blood typing at the turn of the century and the institution of blood banks in the 1930s led to the almost exclusive use of allogeneic (homologous) blood up to and following World War II. 12 In 1917, Elmendorf published a description of the first case of autotransfusion in a patient with traumatic hemothorax. 11 In 1886, Duncan published the first known human account of autotransfusion in which he reinfused shed blood in a patient with a traumatic amputation without any notable ill effects.
Reports of autotransfusion can be found as early as 1818 when Blundell, an English practitioner, reinfused shed blood after witnessing a woman exsanguinate from uterine hemorrhage. Clinicians practicing in more austere environments with a paucity of clinical resources, such as combat and disaster zones, may find that the procedure’s benefits outweigh its risks. Since the procedure requires familiarity with the equipment, continuing education, and quality control, it may be counterproductive to institute it in a hospital that has a low trauma census or in a setting in which it will be used infrequently enough that staff education issues are problematic. Though not a uniform standard of care, it is applicable to any ED. 2– 7 Autotransfusion in the emergency department (ED) is usually limited to patients with severe, traumatic hemothorax and clinically significant blood loss.Īutotransfusion is usually performed in trauma centers or in EDs with high trauma volume. 1 Preoperative blood banking and intraoperative cell salvage techniques have increased in a multitude of surgical specialties. Autologous blood transfusion, or autotransfusion, is the collection and reinfusion of a patient’s own blood for volume replacement.
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