A Comparative Study Of Autologous Versus Homologous Blood Transfusion During General Surgery

摘要

The objective of this study was to find out whether autologous blood transfusion will avoid homologous blood transfusion or not in our set-up during general surgery and to find out advantages and disadvantages of autologous blood transfusion.The aim was also to realize whether autologous blood transfusion can be introduced on a large scale in General Surgery. Introduction Autologous blood transfusion can be defined as ‘Retransfusion of whole blood or its components which has been donated by intending recipient’1. A recipient, who serves as his or her own donor, receives the safest possible transfusion2. So, the autologous blood transfusion is one of the safest procedures to avoid the hazards of blood transfusions like HIV, HBV, HCV etc., immune-related problems, intravascular hemolysis and circulatory overload. This study is a sincere effort towards providing the data about predonated autologous blood transfusion in the clinical field. Categories Of Autologous Blood Transfusion Acute Normovolaemic Haemodilution (ANH) and short term storage of blood.1 Predeposited autologous blood donation.1 Intra-operative cell salvage method.13 Post-operative cell salvage method.1 ANH is preferred in the present study because it is convenient, as it is performed just before the time of surgery on the operation table, no help from the blood bank is required and we can also monitor hemodynamics as well as haematological changes before, during and after hemodilution. Material And Methods The study was performed by using one of the methods of autologous blood transfusion, which is Acute Normovolaemic Haemodilution and short term storage of blood, in which blood is withdrawn just before the induction of anaesthesia with simultaneous infusion of crystalloids to maintain the blood volume.Thirty patients, admitted from November 2007 to October 2008 in different surgical wards of G.G.Hospital, Jamnagar, were selected (group A).Thirty control patients, admitted during the same period were selected who received homologous blood transfusion during surgery (group B). In both groups, expected blood loss was 350cc or more.All the patients were screened for HIV, HBSAg, syphilis, etc., before the selection.The criteria for patient selection were Age: 20-50yrs Weight: >45kg Hb%: >10g Haematocrit: >30%. All the patients were explained the advantages of this method and written consent was taken from all the patients before surgery. Permission from the ethical committee was taken for this study.Patients were premedicated for surgical operation whenever required. Patients were taken to operation theater and all vital parameters were recorded.THE TECHNIQUE WAS AS FOLLOWS:A pre-operative blood sample was collected to measure Hb% and haematocrit values one day prior to surgery. Two blood pressure cuffs were applied on both arms, one for tapping the blood and other for blood pressure measurement. Before collection of blood CPD-A (Citrate Phosphate Dextrose-Adenine) bags were tested for patency and each bag was tilted to fill the system with CPD-A solution to avoid coagulation at the time of collection.Equipments listed below were kept ready: CPD-A plastic bags with a capacity of 350ml containing 49ml of anticoagulant EDTA bulbs Sphygmomenometer, weight scale, syringes with needles Betadine, Spirit, Sevlon Sterile cotton swabs, bandages Emergency drugs, Oxygen cylinders, bag and masks, laryngoscope and trachea tubes The antecubital area of the arm was selected for collection of blood. The blood pressure cuff was inflated just above the initial diastolic pressure and a selected vein was punctured with a 16G needle which is incorporated with the CPD-A bag. The bag was shaken gently at time intervals to avoid coagulation during tapping; 350ml of blood was withdrawn within 10min and simultaneously the solution of Ringer’s Lactate (3 to 4 times more than the withdrawn blood) was infused fast. As soon as the required amount of blood was collected, the tubing was clamped with