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Fri Jan 23 12:27:48 GMT 2009

Christos,
Thanks for the summary, and references!
Take care,
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Christos Giannou
Sent: Thursday, January 22, 2009 5:04 PM
To: trauma-list at trauma.org
Subject: Re: Autotransfusion

Dear friends,

When I receive my mailing there is a repitition, sometimes several, of the
various postings. Sorry, if in the middle of them all, I have missed
someone.

Dr McSwain gave a succinct summary of the indications: critical patient,
lack of blood in-time. We don't perform an autotransfusion for a small
haemothorax 500-1000 ml; crystalloids should suffice. The need is usually a
straight forward clinical observation; life-threatening shock in a chest or
abdominal trauma patient, or ectopic pregnancy, and not enough time to
obtain blood or none is available. He also confirmed (thank you for the
references) the anecdotal evidence of our Russian colleague (Professor
Minoushin, formerly of the St Petersburg Military Medical Academy) about
enteric contamination.

Again, I have tried with and without anticoagulants, and it doesn't seem to
matter; again confirmed by several colleagues.

As for Brad, and whether his well-equipped Australian hospital would ever
require such a technique, he may well need it in the out-back some day.
Nonetheless, if you have the BRAT or Cell Saver, or the autotransfusion
module on Pleur-Evac, so much the better. Otherwise, two situations present
themselves: abdomen and chest.

Peter in Italy, when working in Africa, keeps a large soup ladle sterilised
and in his emergency equipment set. A kidney dish will also do very well.
What is really useful is a metal funnel. I line this with my 6 layers of
gauze compresses and place it into my glass bottle and ladle or scoop the
blood into it. Fills quite easily.

The metal funnel, gauze compresses, and bottle can also be put directly
underneath the open end of the chest tube. (I include a sketch from an
article in Tropical Doctor.) Alternatively, you can collect the blood in a
urine bag or, as several colleagues have mentioned, the drainage reservoir.
Having diagnosed a massive haemothorax clinically that will probably require
autotransfusion, I do not have an underwater seal in the reservoir if I am
using this.

The most important thing is to be prepared. In the ICRC, we try to arrange
some sort of autotransfusion device to be available before any patients
arrive.

A few other references:

Ahmed AM, Sabrie MH, Baldan M. Autotransfusion in penetrating chest war
trauma with haemothorax: the Keysaney Hospital experience. East Cent Afr J
Surg 2003;8:51-54.

Baldan M, Giannou C, Rizzardi G, Irmay F, Sasin V. Autotransfusion from
haemothorax after penetrating chest trauma: a simple life-saving procedure.
Tropical Doctor 2006; 36: 21-22.

Carrol P. Salvaging blood from the chest. RN 1996;59:32-39.

Cheesbrough M. Blood transfusion practice. In: Cheesbrough M, ed. District
Laboratory Practice in Tropical Countries. Part 2. UK: Cambridge
UniversityPress, 2000: 354.

Cook J, Sankaran B, Wasunna AEO. Fluid and electrolyte therapy, blood
transfusion, and management of shock. Chest. In: Cook J, Sankaran B, Wasunna
AEO, eds. General Surgery at the District Hospital. Geneva: WHO, 1988:
43-92.

King M, Bewes P, Cairns J, Thornton J. The surgery of pregnancy:
autotransfusion. In: King M, Bewes P, Cairns J, Thornton J. eds. Primary
Surgery: Non Trauma. Vol. 1. Oxford: Oxford University Press, 1993: 241.

Jevtic M, Petrovic M, Ignjatovic D, et al. Treatment of wounded in the
combat zone. J Trauma 1996;40:173-176.

Oltjen AM, Santrach PJ. Autologous transfusion techniques. J Intraven Nurs
1997;20:305-310.

Parker-Williams EJ. Autologous blood transfusion. Postgrad Doctor Africa
1989;11:52-55.

Marquis MC, Gyger D. Autotransfusions peroperatoires en zone rurales
africaines: une solution d'urgence. Labor Med 1998;9:284-285.

Roostar L. Clinical pictures of penetrating chest injuries: infusion therapy
and haemotransfusion. In: Roostar L. Gunshot Chest Injuries. Tartu, Estonia:
Tartu University Press, 1996: 33-34.

cheers

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