Intraoperative Autotransfusion

Abstract

Autologous intraoperative transfusion employing the Hemonetics Cell Saver is reported in 725 patients from a general hospital population, of which 75% were cardiovascular patients. The remaining cases included various orthopedic procedures, splenectomy, craniotomy, ectopic pregnancies, Caesarian sections and exploratory laparotomy. On occasion, this method was utilized in trauma and pediatric surgery. The product of washed red blood cells gave an average yield of 573 cm3/case with an average hematocrit of 55 cm3/dl available for autologous infusion. In 100 consecutive open heart procedures operated prior to the Cell Saver period, an average of 1.97 U of bank blood was used during operation, as compared with 0.75 U in 100 consecutive cases studied employing the Cell Saver (P < 0.0001). Homologous blood use during cardiac surgery declined > 50% with the use of the Cell Saver. Quality control was monitored scrupulously and included special precautions against air embolism, abnormal coagulation and sepsis. The overall mortality rate was 2.8%, and in no instance was mortality or morbidity ascribable to the autologous transfusion. Numerous advantages offered by autotransfusion include prevention of sensitization of the recipient to various antigens in donor erythrocytes, leukocytes, platelets and plasma, and avoidance of transfusion-transmitted diseases, especially viral hepatitis. Additionally, autologous blood, the only perfectly compatible product, provided immediate availability while conserving blood bank resources. In circumstances in which the intraoperative blood loss exceeded 1000 cm3 in the adult, its use was observed to be cost-effective. Here, autotransfusion proved safe, efficient and in some instances life saving.