about ABT

patient information

Karen Madgwick, Hospital Transfusion Specialist, from North Middlesex University Hospital NHS Trust, explains in more detail what happens to patients during Autologous Blood Transfusion.

Orthopaedic patient, Paul Grieves, also tells of his experience:

-Karen's guide to the medical facts
Appropriately used donor blood and blood products save lives and provide clinical benefit to many patients. However, blood is in short supply

-Karen's view of a patient's experience
What happens prior to the operation?
Is there anything I could do to prepare?
How long does the procedure take? ...more

-Case Study: Paul Grieves

Paul Grieves from Harlow, Essex had his own blood back following on from a bi-lateral knee replacement operation at the town’s Rivers Hospital ...more


Having Your Own Back
Appropriately used donor blood and blood products save lives and provide clinical benefit to many patients. However, blood is in short supply. Each year, reflecting the age of the population and increased complexity of surgical and medical procedures, the demand for blood increases. Sometimes blood lost in surgery may be replaced by collecting and re-infusing the patient’s own blood. Below are some of the methods that can be used to collect a patient’s own blood for reinfusion:

Acute Normovolaemic Haemodilution (ANH):
This involves the collection of whole blood from the patient immediately prior to surgery. Approximately 500ml of blood is withdrawn into each bag (1000 – 1500ml in total) with normal saline solutions being re-infused back in order to maintain a normal blood volume. This fresh blood, containing active platelets and clotting factors, may be stored for up to six hours and re-infused as appropriate. As this happens just prior to surgery, whilst or just after you are being anaesthetised this is not painful and you will not know anything about the procedure.

Post-operative salvage
Another method of collecting the patient’s own blood for re-infusion is called Post-operative salvage (POS) or Autologous Blood Transfusion (ABT). This involves the collection of blood after the surgery has been completed using surgical drains. This blood would normally be collected via wound drains and then discarded but instead it is filtered, or washed, and then re-infused. This technique is effective where there is likely to be predictable post-operative blood loss and where blood is relatively ‘clean’. This technique has been very useful in minimising the use of donor blood in orthopaedic surgery, such as knee replacement surgery, where the use of a tourniquet means that most blood loss occurs post-operatively.

Intra-operative salvage
However careful the surgical technique blood is often lost during the operation. Sometimes this blood instead of going to waste down the drain, can be salvaged and recycled. A system that collects the patient’s blood during an operation is called Intra-operative salvage (IOC) or Autologous Blood Transfusion (ABT). This uses machines called ‘cell savers’. Blood collected during surgery is aspirated (sucked) from the sterile surgical field. The effluent containing clots, white blood cells and cellular debris is discarded and the important oxygen carrying red cells are processed (washed) and collected into a bag for re-infusion. This process all happens whilst you are asleep and undergoing the surgery so you would not know anything about the collection and usually the blood is returned to you whilst you are in theatre. This system can be set up as a continuous circuit which may be acceptable to patients who decline transfusion of donor blood for religious reasons.

None of these procedures require an investment of time by the patient as the blood is obtained at the time or just after surgery. The best means of collecting and returning your own blood to you will depend on the type of surgery you need to have and your clinical condition. Often several of the above techniques can be used together as part of an integrated approach to minimise the exposure of patients to homologous blood. Should you be interested in any of these you should ask the surgical team before you attend for surgery. This would usually be during your pre-assessment clinic (the appointment with the hospital to discuss your operation).

You can also help by doing simple things. Eating a well-balanced diet can reduce the need for using blood during an operation as this maximises the amount of red blood cells that your body makes. If you have been anaemic in the past an iron and/or B12 supplement may help. You should discuss this with your General Practitioner or the surgical team at the hospital.