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► Pre-operative autologous deposit (PAD) |
Blood may be collected and stored (usually fresh or occasionally frozen) prior to planned surgery.
In Australia, the number of autologous collections rose sharply in the late 1980s due to fears of human immunodeficiency virus (HIV) infection.
Although this was a justifiable response at the time, there have since been considerable resources directed towards minimising the infectious risks of allogeneic blood transfusion, including the recent introduction of nucleic acid testing for HIV, Hepatitis B and Hepatitis C.
PAD is rarely indicated and should only be used in specific circumstances where compatible allogeneic red cells are difficult or impossible to obtain.(1) In such circumstances the blood should probably be collected over a longer period of time and frozen for optimal preservation.
The marginal benefit in minimising allogeneic transfusion is offset by additional risks to which the patient may be exposed. Moreso, continuation of these practices could not be justified on clinical or cost-benefit grounds, given the current quality and safety of Australia's blood supply.(1)
PAD should be available to those patients with rare antibodies or who wish to use it as a matter of personal choice.(1)
This is a technique of autologous blood removal immediately prior to surgery, with volume replacement by crystalloid solutions and reinfusion of the blood during or after surgery.
This technique has been widely used in cardiothoracic surgery. However, its benefit (solely for reducing the use of allogeneic red cells) is marginal and generally not cost-effective.
There may be significant advantages when this technique is combined with the perioperative preparation of plasma, platelet concentrates +/- platelet fibrin gel and the use of intraoperative blood salvage technique.
Such approaches require appropriate equipment, resources, training, a quality management system and commitment of clinical staff to safe and effective implementation.
This is a technique in which shed blood is collected and processed for reinfusion. Systems designed to collect and reinfuse shed blood range from the simple to the complex.
These should not be used where there is infection or malignancy in the operative field. Quality assurance systems should be in place where perioperative blood salvage is utilised.(2)
Fibrin sealants generally contain two major components:
fibrinogen (with or without factor XIII), and
These can be applied topically to the wound surface sequentially or simultaneously, using single or dual syringe systems in liquid or aerosolised form.
Fibrin sealants mimic the final phase of the coagulation cascade through the activation of fibrinogen by thrombin that, via a series of complex reactions, leads to the formation of a semi-rigid clot.
A systematic review of using fibrin sealant to minimise perioperative allogeneic blood transfusion shows these are efficacious.(3) However, large methodologically rigorous trials with clinical outcomes are needed.
The use of autologous fibrin sealant has become more popular as there is no risk of donor viral transmission but the thrombin used in this preparation is usually bovine.
A fibrin sealant using human thrombin is commercially available. Allogeneic donor-derived cryoprecipitate is also available from the Blood Service for preparation of fibrin sealant.
