Dr. Dharmakanta Kumbhakar
Blood transfusion, commonly practiced in human beings, is mainly of two types - homologous blood transfusion and autologous blood transfusion. Out of these two practices, homologous blood transfusion was the sheet anchor till 1970. But since 1970, when the autologous blood transfusion was approved for practice in the USA, the homologous blood transfusion started losing its monopolistic control over the blood transfusion practice, particularly due to the associated hazards of transfusion-transmitted infections and transfusion reaction in homologous blood transfusion. Autologous blood transfusion, when used appropriately, can provide a safe alternative to allergenic homologous blood transfusion. Autologous blood transfusion is becoming popular recently in our country also andis expected to play a significant role in the future blood transfusion practice in India.
What is Autologous Blood Transfusion?
Autologous (auto-self) blood transfusion is the re-infusion of collected blood simultaneously or on later dates into the donor himself/herself. This is in contrast to homologous blood transfusion where blood from unrelated/anonymous donors is transfused to the recipient. In autologous blood transfusion, the patient is himself/ herself the blood donor. It requires the written request from the treating physician, who would indicate the justification and specific advantages of autologous blood transfusion.
For autologous blood transfusion, rigid donor selection criteria required are not required. However, donation of pre-deposit autologous blood transfusion shall not be undertaken when the donor patient has been, or is being, treated for bacteraemia or has any local skin lesions. Pre-deposit donation for autologous blood transfusion shall not be drawn within 72 hours of the anticipated operation or transfusion. The volume of blood collected shall be proportionate to the donor patient's weight and volume of preservative used. The responsibility of determining the suitability of blood collection from the donor patient rests jointly on the blood bank physician and the treating physician. The transfusion of autologous blood units should be under medical supervision.
Autologous blood transfusion technique:
1. Cell salvage: Blood is collected from suction, surgical drains or both, and re-transfused back to the patient after filtration or washing.
2. Preoperative Autologous blood donation: Blood is collected in advance of an elective procedure, stored in the blood bank and transfused back to the patient when required.
3. Acute normovolae michaemo dilution: Blood is collected immediately prior to surgery and blood volume is restored by crystalloid or colloid. The blood is then re-transfused towards the end of surgery once haemostasis is achieved.
Advantage of Autologous blood transfusion:
Autologous blood transfusion prevents complications of allergenic homologous blood transfusion, like transfusion of transmitted infection, allo-immunisation and transfusion reaction.
Conservation of blood resources:
1. Avoidance of immunosuppressive effects of allergenic homologous blood transfusion.
2. Patients with rare blood groups are particularly benefited.
3. The technique reduces work load as autologous blood transfusion does not need cross-matching and tests for transfusion of transmitted infections.
4. It allows the availability of fresh whole blood transfusion.