Intra operative blood conservation

1. Intra operative blood conservation

2. Intra operative blood conservation

3. Advantages of autologous blood Intra operative blood conservation AUTOLOGUSBLOOD TRANFUSION

4. Comparison Intra operative blood conservation AUTOLOGUSBLOOD TRANFUSION

5. Autologus Transfusion • PAD/SFDN-Pre op autologus donation. • ANH-Acute normovolumic hemodilution • ICS-Intra operative cell salvage Intra operative blood conservation AUTOLOGUSBLOOD TRANFUSION TYPES

6. ICS Intra op cell salvage Intra operative cell salvage Intra operative blood conservation • The technique of collecting and reinfusing blood lost by a patient during surgery.

7. Intra operative blood conservation HISTORY • 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 ICS Intra op cell salvage

8. Blood salvage procedures Intra operative blood conservation TYPES 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

9. Cell processor Intra operative blood conservation Method

10. Cell processor Intra operative blood conservation Method

11. Method Intra operative blood conservation 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.

12. Method 2.STORAGE Intra operative blood conservation • 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.

13. Method Intra operative blood conservation 3.CENTRIFUGE 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

14. Method 4.washing Intra operative blood conservation 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.

15. Method Intra operative blood conservation 5.Waste separation Waste products include white blood cells, platelets, plasma, anticoagulant, fat and free plasma haemoglobin. These are collected in a bag.

16. Method Intra operative blood conservation 6.Processed RBC Packed red blood cells are separated from waste products and collected in a separate bag

17. Method Intra operative blood conservation 7.Reinfusion 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.

18. Intra operative blood conservation CELL SAVER DEVICES

19. Intra operative blood conservation Practical considerations

20. Ultrafiltration Intra operative blood conservation Ultrafiltration of Whole Blood • 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.

21. Ultrafiltration Intra operative blood conservation Ultrafiltration of Whole Blood 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

22. Direct transfusion Intra operative blood conservation DIRECT TRANFUSION 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

23. Thank you