Question

70 lb child was scheduled for surgery and the doctor has requested the use of autologous RBCs. On the day of surgery, the patient becomes ill and surgery is postponed. Because of the tight operating room schedule, the surgery cannot take place for 2 months. Do the units need to be discarded and redrawn? Do any options exist?

Answer 1

I) In autologous RBCs is preserved through various methods

a) Traditional anticoagulant/ preservatives

CPD and CP2D allows whole blood/RBCs to use 21 days from the day of collection

CPD - Citrate-phosphate-dextrose

CP2D Citrate-phosphate-dextrose-dextrose

b) Citrate phosphate dextrose adenine (CPDA-1) preservates allows whole blood/RBCs to use 35 days from the day of collection, Because it contains extra adenine when compared to CPD and CP2D as a source of ATP

c) Additive solutions which have more adenine and dextrose will allow whole blood/RBCs to 42 days from the day of collection. Additive solution are in various forms and is named as AS1 (Adsol), AS-3 (Nutricel) and AS-5 (Optisol).

If these preservatives are used in the above mentioned childs autologous stored RBCs it must be discarded and redrawn again or select other methods of blood transfusion before or during the time of his next scheduled date of surgery.

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2. Other options do exist

Frozen RBC products

In this method the RBC is freeze with 40% glycerol, store at -65 degree celcius for 10 years or freeze with20% glycerol store at -120 degree celcius.

This RBC can be use for 10 years

Before Using

The product should be thaw upto 30 minutes to convert it into 37 degree celcius

Deglycerolize should be done before using to the patient with the help of Sodium chloride solution 0.9% or 0.2% dextrose solution.

After deglycerolization in can be use upto 24 hours if store properly in 1 - 6 degree celcius.

Deglycerolization means removal of glycerol, WBC fragments and plasma.

Once thawed and not needed If the blood is extremely a rare type it can be refrozen after rejuvenation using glycerol.