Autotransfusion

Autotransfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously "pre-donated" (termed so despite "donation" not typically referring to giving to one's self) before a surgery, or alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device (such as a Cell Saver or CATS). The latter form of autotransfusion is utilized in surgeries where there is expected a large volume blood loss - e.g. aneurysm, total joint replacement, and spinal surgeries.

The first documented use of "self-donated" blood was in 1818, and interest in the practice continued until the Second World War, at which point blood supply became less of an issue due to the increased number of blood donors. Later, interest in the procedure returned with concerns about allogenic (separate-donor) transfusions. Autotransfusion is used in a number of orthopedic, trauma, and cardiac cases, amongst others. Where appropriate, it carries certain advantages - including the reduction of infection risk, and the provision of more functional cells not subjected to the significant storage durations common among banked allogenic (separate-donor) blood products.

There is some evidence that in 1785 Philip Physic of Philadelphia transfused a post-partum patient. However the first documented use of autologous blood transfusion was in 1818 when an Englishman, Rey Paul Blundell, salvaged vaginal blood from patients with postpartum hemorrhage. By swabbing the blood from the bleeding site and rinsing the swabs with saline, he found that he could re-infuse the result of the washings. This unsophisticated method resulted in a 75% mortality rate, but it marked the start of autologous blood transfusion.

During the American Civil War Union Army physicians are said to have administered four transfusions. In 1886, J. Duncan used autotransfusion during the amputation of limbs by removing blood from the amputated limb and returning it to the patient by femoral injection. This method was apparently fairly successful. A German, M. J. Theis, reported the first successful use of intraoperative autotransfusion in 1914, with a ruptured ectopic pregnancy. The earliest report in the American literature on the use of autotransfusion was by Lockwood in 1917 who used the technique during a splenectomy for Banti syndrome. Interest in the unrefined technique of autotransfusion continued through to the early 1940s, and was applied to various procedures including treatment of ectopic pregnancy, hemothorax, ruptured spleen, perforating abdominal injuries, and neurosurgical procedures.

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