1. Autotransfusion (“Cell Savers”): rev 2016-02-08
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2-14,18,23,24-28
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2. Autotransfusion Systems
or “Cell-Savers”
© D. J. McMahon rev cewood

3. 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

4. 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”

5. 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: Male: Newborn:
Originally determined by spinning a tube of blood in a hematocrit centrifuge at 10,000 rpm for 5 minutes.

7. 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).

8. 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.

9. Latham Bowl
Alternate type of bowl (Medtronic):

11. 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).

13. 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.

14. Medtronics Sequestra 1000

18. 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

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

24. Haemonetics “Cell Saver 5”

25. Haemonetics “Cell Saver Elite”

26. Haemonetics “OrthoPAT”

27. Medtronics “Autolog”

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