Blood recycling eliminates need for blood
Online posting: April 19, 1996
Published in print: Aug. 1, 1996 (CMAJ 1996;155:275-276)
Re: Jehovah's Witnesses leading education drive as hospitals adjust to No Blood requests, by Nancy Robb, CMAJ 1996; 154: 557–560 [full text]
This article reviewed the trend toward reducing and often
eliminating the use of banked or homologous blood in medical
care. The dangers of transmitting HIV and hepatitis C through
homologous blood transfusion are well known. Medical centres from
coast to coast are reducing the need for blood in many ways,
including the banking of the patient's own blood in preparation
for surgery. However, little mention has been made of a further
development in autotransfusion.
In emergency surgery or in unexpected blood loss during any type
of surgery, there is no time to bank the patient's blood. In the
past, vast amounts of conventional, banked blood have been
transfused as a life-saving measure, with the attendant risk of
HIV and hepatitis C infection.
Today we can recycle the patient's own blood in the operating
room during surgery. The shed blood is purified by filtration and
returned to the patient during the operation. The required
apparatus is simple, cheap and disposable.
In research with my colleagues in Toronto and London, Ont., I
have clearly shown that almost unlimited amounts of blood can be
salvaged from the incision and then simply and safely returned to
the patient.[1–3] This measure has saved lives in circumstances
in which nothing else could have been done.
During our research, 150 patients, including many Jehovah's
Witnesses, were never turned down, whether they had trauma, an
aneurysm or heart disease necessitating open-heart surgery. No
deaths occurred because of autotransfusion during surgery. We
often successfully recycled more than 27 units (13 000 mL) of
blood during a 3-hour operation, with excellent clinical results
and a pleasing postoperative coagulogram. Compare this with the
gross hematological changes after giving a patient 27 units of
banked blood during 3 hours of surgery!
The equipment required to recycle blood was neither costly nor
sophisticated. It consisted of a disposable reservoir and filter
($75) and a reusable electric blood pump ($2000 new, but often
found in dusty hospital cupboards). Cell-washing apparatus was
not required. Ours was a simple, continuous process of withdrawal
and filtration of blood pooling in the wound, with immediate and
continuous return to the patient.
The theoretical problems that could arise from this procedure —
tumor-cell infusion, infection or coagulopathy — have not
occurred in our experience. Lives have been saved by the decisive
use of unlimited autotransfusion, and many more will be saved in
the future.
Raymond O. Heimbecker, MA, MD, FACS
Professor emeritus
University of Western Ontario
Former surgeon
Toronto General Hospital
Collingwood, Ont.
References
- Wall W, Heimbecker RO, McKenzie FN et al: Intraoperative
autotransfusion in major elective vascular operations: a
clinical assessment. Surgery 1976; 79: 82–88
- Wall W, Heimbecker RO, McKenzie FN et al: Platelet and
fibrinogen preservation in intraoperative autotransfusion.
In Grayson J, Zingg W (eds): Microcirculation, vol 1,
New York, Plenum Publishing, 1976: 222–223
- Heimbecker RO: Transfusion without fear. [editorial] Med
Post 1995; Nov 14: 8
CMAJ email
CMAJ Readers' Forum