A Case of Intraoperative Blood Salvage and Retransfusion

Abstract

SM Sharma, ZZ Ali, A Case of Intraoperative Blood Salvage and Retransfusion. 2003; 23(5): 294-295 Retransfusion of autologous blood collected fron body cavities may be a life-saving measure when compatible homologous blood is not available. It may also prove to be a blessing in disguise because it eliminates the possibility of transfusion hazards such as iso-immunization, mismatch, and transmission of diseases. Spread of HIV and AIDS through the use of whole blood and blood products lends further support to the use of autohemotransfusion. 1,9,10 Use of blood collected from the peritoneal cavity in patients suffering from a ruptured ectopic gestation or splenic rupture has been a fairly common practice in the past.2 Despite being the most readily available source of compatible blood this method has not gained wide clinical importance because of cumbersome technique and lack of adequate knowledge about changes occurring in the blood shed into body cavities before and during the procedure of collection and retransfusion.3 Use of blood obtained by intraoperative salvage may be complicated by hemolysis, disseminated intravascular coagulation, sepsis and air embolism. 4 Various techniques have been employed for collection, filtration and transfusion of salvaged blood.7 A successful case of retransfusion of salvaged blood using a simple technique is reported. Case ReportA 25-year-old female was admitted with complaints of hypogastric pain and vomiting of 4 days' duration. She was not constipated, but had a low-grade fever (37.6°C). On admission she had a haemoglobin of 10 g/dL with a haematocrit of 30%. She had mild tachycardia (heart rate 110/min) with an arterial pressure of 98/70 mm Hg. Next morning (about 20 hours later) she was found to be grossly anaemic with the haemoglobin level having dropped to 5.0 g/dL. A peritoneal tap was haemorrhagic. No compatible blood was available in the hospital as the patient was found to belong to the B Rh-negative blood group.In view of intra-abdominal bleeding an emergency laparotomy was performed. Before incising the peritoneum arrangements had been made to collect the blood in the peritoneal cavity into sterile bottles containing acid-citratedextrose solution through a sterile 1.8 meter long rubber tube of 5 mm internal diameter. Approximately 2 litres of blood could be collected in about 7 minutes using a high vacuum suction apparatus. This blood was sieved aseptically through two layers of sterile gauze moistened with isotonic saline (0.89% NaCl solution) into four 500 mL capacity autoclaved glass bottles. On opening the abdomen a ruptured ectopic gestation was found. It was managed by the gynaecologist.Anaesthetic management consisted of inducing anaesthesia with diazepam (5 mg) and ketamine (75 mg), endotracheal intubation facilitated by use of suxamethonium (50 mg). Anaesthesia was maintained using pancuronium (6 mg), morphine (6mg), nitrous oxide and oxygen (50:50). Intra-operatively, crystalloids (1.5 L) including 1000 mL of lactated Ringer's solution, and 500 mL of i...