July 20, 2010 -- During trauma surgery, blood loss is an unfortunate reality. Usually, this blood replaced using the pints given by generous donors across the country. But new research suggests that collecting, cleaning, and reinfusing a patient's own lost blood during surgery -- a process called "autologous transfusion" -- is a safe, effective, and cost-saving alternative.
A small study of 94 emergency trauma surgery patients showed that those receiving their own blood required fewer units of packed red cells and fresh frozen plasma than those receiving donor transfusions. The shed blood was vacuumed from the surgical field, mixed with heparin sodium to prevent clotting, and pumped to a sterile container for reinfusion.
"Centers with access to a cell salvage program should routinely use autologous transfusion as part of their intraoperative resuscitation. More important, centers not currently using intraoperative cell salvage and autotransfusion should identify and overcome barriers to implementing this life-saving technique," reported Dr. Carlos V.R. Brown of University Medical Center Brackenridge in Austin, Texas, and colleagues in the Archives of Surgery.
Currently more than 38,000 blood donations are needed every day in the United States, according to the American Red Cross.
Not only was the amount of blood needed lower in the autologous transfusion group, so was the price tag, averaging $1,616 including the cost of cleaning and processing the shed blood compared to $2,584 in donor transfusion group. There was no difference in death rates or average duration of hospitalization between the patients receiving their own blood and those receiving donated blood.
The researchers called for additional studies "to definitively confirm the safety of transfusing contaminated blood, to preoperatively identify patients who would most benefit from autologous transfusion, and to optimize cost-effectiveness." However, they argued that their own results should quell objections traditionally raised against reusing trauma patients' shed blood, such as risk of infection and blood clots and the anticipated cost.
All the patients in the study underwent emergency surgery at University Medical Center Brackenridge, a level I trauma center in Austin, in 2006 and 2007. Patients in the two groups were matched according to age, sex, type of surgery, injury type (penetrating or blunt trauma) and injury severity.
Limitations to the study included its retrospective, nonrandomized design, the lack of specific data on infections and clotting-related complications, and the exclusion of more than one-third of patients receiving autotransfusions.