autologous transfusion

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I started doing autotransfusion from a massive haemothorax in Beirut in
1980, where there was no lack of blood in the bank. Have continued doing so
ever since; last large effort (about 25 cases in three months) in the
fighting in Monrovia, Liberia, 2003, where there was a dire lack of blood.

I have used citrate, heparin, and no anticoagulant ... depending on what was
available, and how criticial the condition of the patient. I have not seen
any difference. Colleagues from Chechnya have told us, during war surgery
seminars that the ICRC has organised there, that they use heparin for their
autotransfusions. Ex-Soviet surgeons working in Afghanistan have usually
used heparin, when available; often they used nothing.

Historically, as far as I know, the first instances of autotransfusion
described in the literature were in African bush hospitals operating on
patients with a ruptured ectopic pregnancy. They usually did not have
citrate or heparin. Important point was to filter the blood (6 layers of
gauze compress).

I did read, many years ago and don't remember the reference, that it was the
microparticulate matter in the shed blood that risked causing the most
problems, hence the need for filtration. Blood recuperated from a
haemothorax is mostly defibrinogenated, and the fluid scooped up in the
peritoneal cavity is what is left after you remove the clot. Theoretically,
heparin might make the most sense (combat DIC). I imagine it would be rather
difficult to organise a prospective comparative trial, however, and this
might remain one of those topics where anecdotal evidence is the best we can
do for the moment.

The easiest technique, whether recuperating blood from the thorax or the
abdomen, is to prepare sterilised glass bottles beforehand, with a stopper
and metal screw-on top. (A certain generation of readers of this list will
remember when ALL i.v. fluids and blood transfusion came in glass bottles,
that were sent back to the factory for re-cycling. Then came the plastic
bag!) Such bottles are easy to find in Africa, and in certain Asian
countries as well. Missionary hospitals usually make their own i.v. fluids,
autoclaving the recycled glass bottles. Too expensive to transport tonnes of
salt / sugar and H2O over long distances and bad roads.

cheers

-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
mob: (++30) 69 74 83 28 18

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