Intraoperative autotransfusion: equipment, protocols, and guidelines.

Blood obtained by intraoperative autotransfusion is: 1) readily available 2) sterile 3) compatible 4) normothermic 5) inexpensive and may be infused rapidly for volume support. We have made extensive modifications to commercially available equipment in order to provide a safe, effective IAT. The effects of IAT in our series of 85 patients are outlined below. Red Cell Mass is reduced after IAT because of irretrievable blood loss and hemolysis, and may be controlled by homologous transfusion when necessary. Red Cell Survival is normal after IAT. Hemolysis. Plasma free hemoglobin is consistently elevated after IAT, but clears within 24 hours. Platelets are normal for patients autotransfused less than 3,500 ml; micropore filters should not be used in cases where greater than 3,500 ml blood is expected to be reinfused; in cases where greater than 3,500 ml is reinfused, 10 units of platelets are recommended for every 3,000 ml of blood reinfused; IAT does effect platelets function; however, platelets circulating within the patient function normally. Coagulation. We use local ACD to eliminate extracorporeal surface clotting. Even with massive IAT we have never demonstrated any clinical or laboratory evidence of intravascular coagulopathy. "Dilutional coagulopathy" may be procuced when greater than 5,000 ml are reinfused, and may be controlled with fresh frozen plasma and platelet concentrates. Bilirubin levels were normal after IAT despite gross hemoglobinuria. Fat emboli were not noted after IAT. Air emboli must be a concern in IAT; HOWEVER, PROPER OPERATION AND EQUIPMENT MODIFICATION MAY ELIMINATE EMBOLI. Renal Failure was not noted after IAT. Alveolar-arterial Oxygen Difference and Blood Gases were normal after IAT. We feel IAT is not necessary if a blood loss less than 1,000 ml is expected. Also, if greater than 3,500 ml is expected additional backup (i.e. homologous transfusions, platelets, fresh frozen plasma) may be required. As banked donor blood reserves become more limited, IAT may become a routine part of general surgical procedures.