Main indications for the procedure
The procedure is used in emergency surgery when it is necessary to urgently restore the lost circulating blood volume in a patient. Retransfusion is advisable in cases of massive internal hemorrhage not accompanied by infection.
Key indications include:
- Gynecological pathologies: ruptured ectopic pregnancy.
- Trauma to parenchymal organs: deep ruptures of the liver and spleen.
- Vascular injuries: ruptures of intrathoracic vascular trunks and mesenteric vessels.
- Thoracic trauma: lung tissue ruptures.
Absolute contraindications
In some cases, the return of shed blood is strictly prohibited due to the high risk of fatal complications, primarily sepsis and the dissemination of pathological cells.
The procedure is not performed in case of:
- Injury to hollow organs (due to blood contact with their contents and inevitable infection). Such organs include the major bronchi, esophagus, stomach, intestines, gallbladder and extrahepatic biliary tract, as well as the urinary bladder.
- Blood contamination with pus, gastric, or intestinal contents.
- Hemorrhage associated with uterine rupture.
- Presence of confirmed malignant neoplasms in the patient.
- Prolonged presence of free blood in the abdominal cavity (if more than 24 hours have passed since the hemorrhage).
Collection and preservation technique
To prevent the shed blood from clotting and make it suitable for return to the bloodstream, it must be properly collected and stabilized.
Stabilization options:
- Use of a special preservative solution in a strict 1:4 ratio.
- Use of sodium heparin solution (standard proportion: 10 mg of heparin dissolved in 50 ml of isotonic sodium chloride solution — this volume is sufficient for one 500 ml bottle).
Technique for collection from a wound or cavity:
- Aspiration method (most promising): blood is collected using a vacuum suction device (with a vacuum of at least 0.2 atm) directly into bottles already containing the stabilizer.
- Manual method (less preferred): scooping out the liquid using a metal ladle or spoon followed by manual filtration.
Preparation and reinfusion
Before returning the collected and stabilized blood into the patient's vein, it must undergo thorough purification from clots, microaggregates, and tissue debris.
A mandatory preparation step is filtration through 8 layers of gauze. This is especially important if a specialized system with a built-in filter was not used during vacuum collection. The transfusion itself is carried out exclusively through an infusion set equipped with a standard microfilter, which ensures maximum safety of the procedure for the patient.
Briefly: answers to topical questions
What devices are used for modern automated blood reinfusion (red blood cell washing)?
Modern automated blood reinfusion uses special Cell saver and Haemolite devices. This equipment ensures the collection of shed blood, its mixing with an anticoagulant, and filtration from clots. Subsequently, the blood enters a rotating bowl where red blood cells are concentrated under the action of centrifugal forces.
Devices used:
- Cell saver — used for intraoperative autologous red blood cell reinfusion.
- Haemolite — used for automated autologous blood transfusion with mandatory red blood cell washing.
An important operational step is washing the red blood cells with saline to clear them of free hemoglobin, clotting factors, and platelets.
What biochemical and morphological changes occur in blood when it remains in a serous cavity for more than 24 hours?
Sources indicate that blood shed into the abdominal cavity differs from vascular bed blood by the following changes:
- decreased platelet count;
- decreased fibrinogen level;
- elevated free hemoglobin level;
- presence of fibrin degradation products (FDPs).
The presence of blood in the abdominal cavity for more than 24 hours is an absolute contraindication to reinfusion.
The "24-HOUR DIRTY ORGANS AND TUMORS" rule helps remember absolute contraindications: blood older than 24 hours, contaminated blood (pus, gastric/intestinal contents), hollow organ and uterine ruptures, and malignant tumors cannot be transfused.
Class and exam questions
Can reinfusion be used for a stab wound to the intestine?
No, this is an absolute contraindication. Damage to the intestine (as well as the stomach, gallbladder, or urinary bladder) leads to blood contact with the organ's contents and its infection.
What level of vacuum is required for automated blood collection?
When using vacuum suction, the negative pressure must be at least 0.2 atm. Blood is collected immediately into bottles with a stabilizer.
How to properly filter blood if it was collected manually?
If the blood was scooped with a spoon or ladle, it must be filtered through 8 layers of gauze before infusion.
What else to study on this topic
- Features of using sodium heparin for in vivo and in vitro blood stabilization
- Specifics of reinfusion in ruptured ectopic pregnancy: risks and benefits
- Differences between transfusion systems with standard microfilters and conventional infusion sets
- Pathophysiological changes in blood remaining in the abdominal cavity for more than 24 hours
Master the entire topic in the "General Surgery" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Blood reinfusion" and 3,335 more subject pages
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- AI tutor answers questions on the topic anytime
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Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.