Autotransfusion (“Cell Savers”): rev 2016-02-08 this is now slide 1 do not print it to pdf things to do (check off when complete): x add revision date to cover page x remove triangles create list for pages to print in the handout 2-14,18,23,24-28 add captions for photo slides incorporate notes taken during presentation add Key Points page 3 2016-02-08, corrected slide 7 pheresis useful characters: ° degrees ‎Ω ohms μ micro ☑ checkbox ☐ slash-zero Ø CO2 O2 SpO2 N2O ® ™ trademarks à 224 E0 á 225 E1 â 226 E2 ã 227 E3 ä 228 E4 å 229 E5 æ 230 E6 ç 231 E7 Ð 208 D0 è 232 E8 é 233 E9 ê 234 EA ë 235 EB ì 236 EC í 237 ED î 238 EE ï 239 EF Ñ 209 D1 Ò 210 D2 Ó 211 D3 Ô 212 D4 Õ 213 D5 Ö 214 D6 Ø 216 D8 ß 223 DF Þ 222 DE Ù 217 D9 Ú 218 DA Û 219 DB Ü 220 DC Ý 221 DD

Autotransfusion Systems or “Cell-Savers” © D. J. McMahon 150512 rev cewood 2016-02-08

Key Points Autotransfusion (“Cell Savers”): Know the general process of autotransfusion (graphic) Know the components of blood and centrifuged blood: plasma, formed elements, including: red cells (erythrocytes) white cells (leukocytes) platelets (thrombocytes) (after centrifuging): buffy coat, consisting of white cells & platelets - Understand the difference between apheresis and autotransfusion - Understand why we need heparin Know the range of a normal hematocrit (HCT, Packed Cell Volume PCV) Know the approximate hematocrit of packed cells produced by autotransfusion

Blood consists of: Plasma: water, electrolytes, and some proteins needed for clotting. Formed Elements: red cells (erythrocytes), white cells (leukocytes), platelets (thrombocytes). (F. E. includes) Buffy Coat: The fraction of an anticoagulated blood sample that contains most of the white blood cells and platelets following density gradient centrifugation of the blood. leuko cyte: “white” + “cell” erythro cyte: “red” + “cell” thrombo cyte: “clotting” + “cell”

The Hematocrit: (or Packed Cell Volume): the proportion of blood volume that consists of formed elements. AIR (least dense) PLASMA BUFFY COAT (white cells & platelets) RED CELLS (most dense) (clay plug) ‘Crit = 46% Normal ‘crits: Female: 36 - 46 Male: 41 - 53 Newborn: 49 - 61 Originally determined by spinning a tube of blood in a hematocrit centrifuge at 10,000 rpm for 5 minutes.

Apheresis, also called ‘pheresis’: The removal of blood from a patient and its separation into plasma, platelets, and red cells. One or more components are retained and the rest are returned to the patient. Autologous Transfusion, also called ‘Autotransfusion’: The removal of blood and reinfusing it to a patient. May include washing with saline and separation of the red cells, which are returned to the patient during a procedure (cell saving).

Essentials of the autotransfusion cycle (part 1): > Blood is sent to a reservoir which already has a small amount of heparinized saline. > As soon as justified by enough quantity and/or quality, ~250 mL of blood is transferred to the Latham Bowl and spun at 5600 rpm. > Most of the red cells accumulate at the outer edges, while the rest remains in the center of the bowl.

Latham Bowl Alternate type of bowl (Medtronic): https://www.youtube.com/watch?v=X_dNqdTxlNY

www.davidfary.com/images/Cell%20Saver%20Animation1.gif

Essentials of the autotransfusion cycle (part 2): > The waste product or “stroma” is sent to a waste bag, and the red cells are rinsed with saline. > The red cells are then transferred to a collection bag, and has a hematocrit of ~55. These “packed cells” are eventually returned to the patient thru an existing IV. > Variations on the cycle are available, depending on the type of case (trauma, orthopedics, etc).

Indications for autotransfusion: > Massive or significant blood loss due to trauma, and/or surgery > Most often used in - Orthopedic surgery - Vascular or Cardiac surgery - Liver resections / transplants > Patients with religious objections to blood transfusion may accept autotransfused blood.

Medtronics Sequestra 1000

Tech Maintenance & Issues: > Power supply values are critical > Centrifuge speeds and displays are verified > Internal calibration is usually through software > Level detector and bubble detector may become dirty and unreliable > Failed disposables can create a bloody mess

Major Players in Autotransfusion: > Haemonetics - Cell Saver 5+, Ortho PAT, CardioPAT, Elite > Medtronics - AutoLog > Terumo (Fresenius) - C.A.T.S. + (continuous processing)

Haemonetics “Cell Saver 5”

Haemonetics “Cell Saver Elite”

Haemonetics “OrthoPAT” https://www.youtube.com/watch?v=71YeN3NA0zM&list=PL49704152C953E4D9

Medtronics “Autolog”

Terumo (Fresenius) C.A.T.S. (continuous auto transfusion system)