Question

A 70-lb child is scheduled for orthopedic surgery in 3 weeks. The physician requests that 2 units of autologous red blood cells be drawn before surgery. Determine the amount to be drawn and the anticoagulant adjustment needed to collect red blood cells from this child if a 500 mL collection bag is used by the facility

Answer 1

Presurgical Blood donation and Autologous Transfusions : The patient who meet blood donation criteria should attempt to donate blood for themselves for their anticipated surgery, this procedure is called an Autologous donation/transfusion.

- This type of donation / transfusion helps to prevent transfusion transmitted infectious diseases, eliminate typically alloimmunization to the cellular elements and proteins.

- also helps to eliminate Graft versus Host Disease (GVHD) and the erythropoietic stimulation caused by repeated Preoperative phlebotomy,

- Recombinant erythropoietin administration can play a significant role in the Autologous donation process by stimulating donor red cell production, so that more blood units are available to donate in a shorter time phase,

- with reference to FDA regulations, a permanent and no removable Autologous lable is required to be placed on all Autologous blood donations,

- If an Autologous blood unit is shipped outside of the collecting facility, it should be tested for HIV-1, HIV-2, HIV p24 antigen, HBsAg, anti-HBC, and syphilis.

Red Blood Cells : when red blood cells are separated , the plasma is removed and then replaced with additive solution containg adenine,saline,glucose and mannitol ( in some cases) or CPD anticoagulant. The ratio of red cells to the additive solution should be approximately 90:10,

- the indication for transfusion of packed red blood cells is to increase the oxygen carrying capacity of blood in the case of acute or chronic anemia patients who are at risk for end organ damage ( eg: subcritical coronary atherosclerosis),

The techniques used for the separation of Blood constituents are Apheresis : The meaning of Apheresis is " to remove" or " to separate". Apheresis technique is involved in the separation of various constituents of whole blood ie: plasma and various blood cells. In Apheresis blood of a donor or patient passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation.

Composition of One Unit of RBC : The volume of one unit of RBC contains approximately 200ml of RBC, 100 ml of additive solution, and 30 ml plasma with a HCT approx 55%. It doubled in case of two units.

Composition of 500 ml of collection Bag: This bag contains

- 70 ml of anticoagulant citrate phosphate Double dextrose solution for collection of 500 ml of blood,

- Each 70 ml contains : 3.57 g dextrose ( monohydrate)

1.84 g sodium citrate,

0.220 gms of citric acid and

0.155 g mono basic sodium phosphate.