Advantages and Indications
Using the patient's own blood is the ideal option for transfusion therapy. The main advantage of the method lies in the complete elimination of complications associated with the use of donor blood. First and foremost, this prevents the recipient's immunization against foreign antigens. Furthermore, the technique elegantly solves the complex problem of finding a compatible medium for patients who have antibodies to rare erythrocyte antigens (beyond the standard AB0 and Rh systems).
Main indications for the procedure:
- The patient has a rare blood type.
- An objective impossibility to find a compatible donor.
- High probability of developing severe transfusion reactions.
- Planned extensive surgical interventions associated with massive blood loss.
However, the procedure cannot be performed on everyone. Contraindications include any inflammatory diseases, severe liver and kidney damage (especially in the cachexia stage), as well as terminal stages of oncological processes.
Methods of Autologous Blood Harvesting
Blood can be collected in advance (during the preparation period for surgery), directly on the operating table before the incision, or collected intraoperatively during the surgical procedure. Preoperative harvesting is called preoperative autologous blood donation.
Standard Technique The exfusion procedure is performed 4–6 days before the expected date of surgery. The maximum volume of blood collected is limited to 500 ml. The physiological rationale for such a pause is extremely simple: within a few days, the body fully restores the circulating blood volume (CBV) by shifting fluid from the interstitial space into the vascular bed. Simultaneously, this process serves as a powerful stimulus to activate the body's own hematopoiesis.
Staged Harvesting If the patient faces prolonged preparation, surgeons can collect significantly larger volumes of autologous blood while preserving all its qualitative characteristics (considering that the shelf life of each portion is only 4–5 days). The volumes with this approach are impressive: up to 1000 ml can be harvested in 15 days, or up to 1500 ml in 25 days.
Staged collection schedule:
- Initial exfusion of 300–400 ml.
- After 4–5 days, this portion is returned to the patient.
- Immediately afterwards, a repeat exfusion is performed, but in a volume 200–250 ml greater than the one just returned.
- This cycle is repeated 2 to 3 times.
This blood is stored in special vials with added preservative at a temperature of +4 °C. If long-term storage is required, freezing at ultra-low temperatures (down to -196 °C) is used.
Autologous Plasma Transfusion
Autologous plasma transfusion is a variant of the method in which blood loss is compensated exclusively by the patient's own plasma.
The patient's own plasma acts as an "ideal" blood substitute. Its use is the best prevention of a specific complication known as homologous blood syndrome.
The harvesting procedure is performed by plasmapheresis. A safe single-dose (one-time) exfusion is 500 ml. If necessary, the procedure can be repeated, but no earlier than 5–7 days later. A dextrose-citrate solution is used to preserve the collected plasma.
In clinical practice, autologous plasma is used either as an independent fluid to replace blood loss or as an important component of complex therapy. The combination of autologous plasma with washed thawed patient erythrocytes is considered most effective.
Briefly: answers to topical questions
What are the main methods of autologous blood transfusion depending on the timing of blood collection?
Depending on the timing of blood collection, there are three main methods of autologous blood transfusion.
- Preoperative autologous blood donation — collection and preservation of the patient's own blood in advance (before surgery).
- Acute normovolemic hemodilution — blood exfusion immediately before surgery with the simultaneous administration of a hemodiluent.
- Intraoperative autologous blood salvage — collection of shed blood during surgery followed by washing of erythrocytes and return into the bloodstream.
What preservative solutions are used to store harvested autologous blood and autologous plasma?
Solutions containing stabilizers and nutrients are used to store harvested autologous blood and autologous plasma.
- Dextrose-citrate solution — used as a preservative during autologous plasma harvesting.
- Glugicir solution — used for blood preservation, providing a shelf life of up to 21 days.
- Tsiglufad solution — used for blood preservation with a shelf life of up to 35 days.
Preservative solutions contain sodium citrate, which binds calcium ions to prevent clotting, as well as dextrose or sucrose to nourish erythrocytes.
What pathophysiological disorders are characteristic of homologous blood syndrome?
Homologous blood syndrome is characterized by disorders in the microcirculation system:
- erythrocyte stasis;
- microthrombosis;
- blood pooling (sequestration);
- changes in blood clotting time.
What devices and techniques are used for intraoperative autologous blood salvage?
Special devices such as Cell saver and Haemolite are used for intraoperative autologous blood salvage.
The technique includes the following steps:
- Collection and filtration — collection of shed blood, mixing with an anticoagulant, and filtration from clots and tissues.
- Concentration — the blood enters a rotating bowl where erythrocytes are concentrated by centrifugal forces while plasma is removed.
- Erythrocyte washing — cleansing the cells of free hemoglobin, clotting factors, and platelets using sterile normal saline (sodium chloride solution).
- Return — pumping the washed autologous erythrocytes into the reinfusion bag and returning them to the bloodstream.
Which erythrocyte antigen systems, besides AB0 and Rh, can cause alloimmunization and transfusion reactions?
In addition to the AB0 and Rh systems, the sources indicate the following minor antigens and erythrocyte systems:
- Kell: K, k, Kpa, Kpb;
- Duffy: Fya, Fyb;
- Kidd: Jka, Jkb;
- MNS.
For transfusions to patients with sickle cell disorders, compatibility for ABO, Rh, Kell, and rare factors is required, as well as a full extended erythrocyte phenotype.
To memorize the staged blood harvesting algorithm, use the "deposit with interest" association: we return the patient's "deposit" (the previous portion) so that the body allows us to immediately withdraw the "deposit + interest" (a volume 200–250 ml larger).
Class and exam questions
Why is no more than 500 ml collected during standard blood donation?
This is the maximum physiologically safe dose for a single exfusion, after which the body is able to independently restore CBV within 4–6 days at the expense of interstitial fluid.
What is the core principle of preventing homologous blood syndrome?
Prevention consists in avoiding donor plasma. The use of a combination of autologous plasma and the patient's own washed thawed erythrocytes completely eliminates contact with foreign antigens.
Can the method be used in patients with advanced stages of cancer?
No. Late stages of malignant neoplasms, as well as severe liver and kidney pathologies (especially the cachexia stage), are strict contraindications to the procedure.
What else to study on this topic
- Pathophysiology of BCC restoration after exfusion
- Mechanisms of hemopoiesis stimulation in blood loss
- Homologous blood syndrome: pathogenesis and clinical features
- Technology of long-term blood cryopreservation at -196 °C
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Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"
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