Transfusion medicine handbook

8. Clinical Alternatives and Applications

8.1 Autologous Blood Collection and Transfusion

Using autologous blood will avoid alloimmune complications and may reduce the risk of many transfusion-transmitted infections (but not bacterial infection).

Autologous blood can be collected several ways, including:

• Pre-deposit autologous donation (PAD) where blood is collected from the patient during the weeks leading up to an elective surgical procedure that would normally involve transfusion. NZBS does not support PAD except in very rare situations where there are clinical reasons for preferring autologous blood, such as multiple red cell antibodies or rare blood groups. In exceptional circumstances where the treating clinician feels PAD is desirable (but not medically justified) then the treating clinician (not the patient or their family) should discuss this with an NZBS Transfusion Medicine Specialist/ Medical Officer.
• Frozen autologous blood where red cells and platelets are collected from patients with rare blood groups or multiple antibodies and then frozen for future use.
• Acute normovolaemic haemodilution (ANH) where a patient donates whole blood immediately before surgery, which is then replaced with intravenous colloid or crystalloid solution to maintain normovolaemia. The removed whole blood is usually returned within several hours, for example at wound closure, providing fresh clotting factors and platelets.
• Red cell salvage

Intraoperative blood salvage: where blood is collected from the surgical site using a cell-saver machine and reinfused after processing (washing and filtering) during or after surgery.

Post-operative blood salvage: where blood is collected from wound drains and reinfused. The salvaged blood may be processed before reinfusion to minimise potential coagulation problems sometimes seen with unprocessed blood.

ANH and red cell salvage are usually performed under the supervision and the responsibility of anaesthetists and/or surgeons.