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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5565_Библиотеки_им_академика_М_И_Перельмана.pdf
AUTOLOGOUS BLOOD 99
________________________________ ________________________________
夝
Question 7: Which statement about the testing of autologous blood donors is NOT
true?
A. If the collecting facility is not the transfusion facility, the first donor unit col-
lected in each 30-day period must be tested for the same transfusion-transmit-
ted diseases as allogeneic donors.
B. If the collecting facility is not the transfusion facility, only the transfusion facil-
ity needs to determine the ABO and Rh type of the donor.
C. Viral tests to screen for hepatitis B, hepatitis C, and HIV do not have to be per-
formed if the collecting facility is also the transfusion facility.
D. Serologic tests for syphilis do not have to be performed if the collecting facility
is also the transfusion facility.
E. If any tests for transfusion-transmitted agents are positive, the collection facility
must notify the transfusion facility.
________________________________ ________________________________
夝
Question 8: Which statement about the labeling and storage of autologous blood is
true?
A. Biohazard labels should not be placed on units if the donor has tested positive
for infectious agents, because of patient confidentiality and the fact that the
units can be issued only to the autologous donor.
B. The standard label for blood components includes the option to designate the
unit as autologous.
C. Autologous units should be placed on a separate shelf or in a separate refriger-
ator so that they are not mistaken as allogeneic units.
D. If a patient has donated multiple autologous units, the units should be labeled
in a way that ensures the freshest unit is transfused first.
E. If not enough autologous units are collected, the operating room staff should
wait until all of the autologous units are transfused before allogeneic units are
requested from the blood bank.
________________________________ ________________________________
夝
Question 9: Which statement about acute normovolemic hemodilution (ANH) is
true?
A. Blood is collected from the patient on admission to the hospital.
B. This process involves removing whole blood and replacing it with an equal
volume of plasma.
100 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
C. The collected blood remains in the operating room as whole blood and can be
reinfused up to 4 hours later.
D. This process may decrease the red cell mass lost intraoperatively, and provide
a source of functional red cells, platelets, and coagulation factors when
needed.
E. ANH is equally likely to be effective for a patient undergoing a surgical proce-
dure in which 2 units of blood are expected to be lost as for a procedure typi-
cally associated with a loss of 10 units.
________________________________ _______________________________
夝
Question 10: When comparing preoperative autologous blood donation with acute
normovolemic hemodilution, which statement is true?
A. Medical restrictions regarding who can participate are similar for both.
B. The administrative burden on the transfusion service is greatly increased with
ANH.
C. Intraoperatively, the order of reinfusion of the collected units is the same for
both (ie, oldest collected is transfused first).
D. Both types typically involve transfusing RBCs, as opposed to whole blood.
E. For cholecystectomy or tonsillectomy, either type could be planned.
________________________________ _______________________________
夝
Question 11: Intraoperative/postoperative blood recovery involves the collection of
a patient’s blood shed during surgery or from sterile surgical drainage sites. Which
of the following statements is true?
A. The maximum allowable storage time of unwashed blood is greater for intraop-
erative/postoperative blood recovery than for ANH.
B. Intraoperative/postoperative blood recovery can be used for patients who do
not meet the qualifications for ANH or autologous donations.
C. There is a greater risk of administrative errors for intraoperative/postoperative
blood recovery than with autologous donation.
D. Levels of coagulation factors and platelets are higher in intraoperative/ postop-
erative blood recovery than for ANH or autologous donated units.
E. The potential cost savings are comparable.
________________________________ _______________________________
夝
AUTOLOGOUS BLOOD 101
ANSWERS
Question 1: Which of the following statements is true about a preoperative autolo-
gous blood donation program?
A. Contributes substantially to the community blood supply.
B. Results in intraoperative blood recovery, sometimes called “cell salvage.”
C. Eliminates the risk of febrile and allergic transfusion reactions.
D. Eliminates the risk of transfusion-transmitted infectious agents.
E. Allows for the transfusion of whole blood, which contains platelets and coagu-
lation factors in addition to red cells, in lieu of allogeneic RBC units.
D. Autologous blood does not eliminate the risk of febrile and allergic transfusion
reactions, probably because cytokines are produced/released during storage regard-
less of whose blood is in the bag. Autologous blood does eliminate the risk of virally
transmitted infectious agents. Preoperative donation does not result in the use of
intraoperative blood recovery techniques by the surgeon; however, the two
approaches can work in concert. Much of the blood donated preoperatively is not
used by that patient and is wasted.
________________________________ ________________________________
夝
Question 2: Which of the following patients might consider participating in autolo-
gous donation?
A. A patient with a hemoglobin level of 10.5 g/dL or hematocrit of 31%.
B. A patient scheduled for surgery in 2 days.
C. A patient with an open, ulcerated skin lesion on his forehead.
D. A G2P1 female who says she “bled a lot” during her first spontaneous vaginal
delivery.
E. A patient scheduled for orthopedic surgery who has no history of cardiac dis-
ease or seizure disorder.
E. The cutoff for autologous donation is a hemoglobin level of 11 g/dL or a hemato-
crit of 33%. Plasma replenishment is fully restored in 3 days; replenishment of red
cells takes several weeks. Most pregnant women should not attempt autologous
donation and open, unhealed skin wounds are a contraindication.
________________________________ ________________________________
夝
Question 3: Which statement about preoperative autologous blood donation is true?
A. About one-tenth of all preoperatively collected units are wasted.
B. The maximum age limit is 65 years of age.
102 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
C. Preoperative autologous donation is also a cost-savings option.
D. Recombinant human erythropoietin is licensed for use in the preoperative
period to increase the red cell mass in the collected autologous unit(s).
E. The maximum surgical blood order schedule, a document prepared jointly by
the transfusion service and surgeons, can serve as a guide for determining
patient eligibility and the number of units of autologous blood that could be
donated.
E. Up to half of autologous donations are not transfused. There are no mandated
limits on the age of patients for autologous donations. Using EPO to boost red cell
numbers before collection of an autologous unit is an “off-label” indication and
adds considerable expense to the cost of collection.
________________________________ _______________________________
夝
Question 4: Which bacterium can proliferate during storage (even at 4 C) and is the
most commonly isolated bacterium in RBC units?
A. Agrobacterium radiobacter.
B. Yersinia enterocolitica.
C. Flavomonas species.
D. Escherichia coli.
E. Staphylococcus epidermidis.
B. Yersinia enterocolitica. Gram-negative organisms are the greatest concern in RBC
units stored in the cold.
________________________________ _______________________________
夝
Question 5: A patient qualifies for autologous donation of several units of blood.
Which of the following statements regarding the typical procedure used by most
physicians is true?
A. The patient will most likely donate blood at 2-week intervals.
B. Collection should begin as close to surgery as possible, preferably no more
than 4 weeks before surgery.
C. The maximum amount of blood that can be drawn at each donation cannot
exceed 1 unit.
D. The physician may prescribe daily oral iron supplements throughout the dona-
tion period.
E. The last donation should be on admission to the hospital.
D. Oral iron supplementation may be prescribed before the start of autologous
blood collection. Female donors with low body mass and limited total body iron
AUTOLOGOUS BLOOD 103
stores may benefit most. All autologous donors can be encouraged to increase their
dietary iron intake.
________________________________ ________________________________
夝
Question 6: Rates of adverse reactions in patients donating autologous blood are the
same as the rates for allogeneic blood donors. Which of the following signs/symp-
toms is helpful in differentiating a vasovagal response from a hypovolemic reaction
(secondary to acute loss of intravascular volume from the donation)?
A. A decrease in blood pressure.
B. A decrease in heart rate.
C. A decrease in oxygen saturation.
D. Postural dizziness.
E. Pallor.
B. In vasovagal reactions, the vagus nerve (parasympathetic) causes a decrease in
blood pressure and heart rate. In hypovolemia, blood pressure also decreases, but
heart rate increases (compensatory response to the decrease in blood pressure).
________________________________ ________________________________
夝
Question 7: Which statement about the testing of autologous blood donors is NOT
true?
A. If the collecting facility is not the transfusion facility, the first donor unit col-
lected in each 30-day period must be tested for the same transfusion-transmit-
ted diseases as allogeneic donors.
B. If the collecting facility is not the transfusion facility, only the transfusion facil-
ity needs to determine the ABO and Rh type of the donor.
C. Viral tests to screen for hepatitis B, hepatitis C, and HIV do not have to be per-
formed if the collecting facility is also the transfusion facility.
D. Serologic tests for syphilis do not have to be performed if the collecting facility
is also the transfusion facility.
E. If any tests for transfusion-transmitted agents are positive, the collection facility
must notify the transfusion facility.
B. Both facilities should determine the ABO and Rh type of the donor. Procedures
are slightly streamlined for units that are collected, stored, and transfused within the
same facility.
104 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
________________________________ _______________________________
夝
Question 8: Which statement about the labeling and storage of autologous blood is
true?
A. Biohazard labels should not be placed on units if the donor has tested positive
for infectious agents, because of patient confidentiality and the fact that the
units can be issued only to the autologous donor.
B. The standard label for blood components includes the option to designate the
unit as autologous.
C. Autologous units should be placed on a separate shelf or in a separate refriger-
ator so that they are not mistaken as allogeneic units.
D. If a patient has donated multiple autologous units, the units should be labeled
in a way that ensures the freshest unit is transfused first.
E. If not enough autologous units are collected, the operating room staff should
wait until all of the autologous units are transfused before allogeneic units are
requested from the blood bank.
C. Because the screening program for autologous units is much less stringent than
for allogeneic units, procedures should be in place to avoid autologous units being
used for patients other than the donor.
________________________________ _______________________________
夝
Question 9: Which statement about acute normovolemic hemodilution (ANH) is
true?
A. Blood is collected from the patient on admission to the hospital.
B. This process involves removing whole blood and replacing it with an equal
volume of plasma.
C. The collected blood remains in the operating room as whole blood and can be
reinfused up to 4 hours later.
D. This process may decrease the red cell mass lost intraoperatively, and provide
a source of functional red cells, platelets, and coagulation factors when
needed.
E. ANH is equally likely to be effective for a patient undergoing a surgical proce-
dure in which 2 units of blood are expected to be lost as for a procedure typi-
cally associated with a loss of 10 units.
D. Normovolemic hemodilution has the theoretical advantage of allowing a patient
to recover red cell mass in the face of loss of volume. By donating red cells and
making up the volume, the patient maintains volume in the face of a lower hemato-
crit. This way when patients bleed, they potentially lose less red cell mass.
AUTOLOGOUS BLOOD 105
________________________________ ________________________________
夝
Question 10: When comparing preoperative autologous blood donation with acute
normovolemic hemodilution, which statement is true?
A. Medical restrictions regarding who can participate are similar for both.
B. The administrative burden on the transfusion service is greatly increased with
ANH.
C. Intraoperatively, the order of reinfusion of the collected units is the same for
both (ie, oldest collected is transfused first).
D. Both types typically involve transfusing RBCs, as opposed to whole blood.
E. For cholecystectomy or tonsillectomy, either type could be planned.
A. ANH is essentially an autologous donation performed immediately before a pro-
cedure where blood loss is expected to be high. Reinfusion of units collected for
ANH should be performed in the reverse manner to collection (newest first, oldest
last) following the guiding principal of ANH to lose less red cell mass than expected
for the volume lost. ANH is collected, stored, and retransfused as whole blood.
________________________________ ________________________________
夝
Question 11: Intraoperative/postoperative blood recovery involves the collection of
a patient’s blood shed during surgery or from sterile surgical drainage sites. Which
of the following statements is true?
A. The maximum allowable storage time of unwashed blood is greater for intraop-
erative/postoperative blood recovery than for ANH.
B. Intraoperative/postoperative blood recovery can be used for patients who do
not meet the qualifications for ANH or autologous donations.
C. There is a greater risk of administrative errors for intraoperative/postoperative
blood recovery than with autologous donation.
D. Levels of coagulation factors and platelets are higher in intraoperative/ postop-
erative blood recovery than for ANH or autologous donated units.
E. The potential cost savings are comparable.
B. Most patients are eligible for intraoperative blood recovery techniques. The blood
saved should not be from an operative site that has a high potential for contamina-
tion (infection, bowel surgery, bone chips, penetrating abdominal injuries, etc). The
blood is located with the patient at all times, reducing the risk of misidentification.
Intraoperatively collected blood expires 4 hours from collection compared to the 8
hours for ANH.
________________________________ ________________________________
夝
106 PRACTICAL SELF-ASSESSMENT FOR TRANSFUSION MEDICINE PROFESSIONALS
SUGGESTED READING
General
American Society of Anesthesiologists Task Force on Perioperative Blood Transfu-
sion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion
and adjuvant therapies. Anesthesiology 2006;105:198-208.
Carless P, Moxey A, O’Connell D, Henry D. Autologous transfusion techniques: A
systematic review of their efficacy. Transfus Med 2004;14:123-44.
Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine:
Blood conservation. N Engl J Med 1999;340:525-33.
Goodnough LT. Autologous blood donation. Anesthesiol Clin North Am 2005;23:
263-70.
Ilstrup SJ, ed. Standards for perioperative autologous blood collection and adminis-
tration. 4th ed. Bethesda, MD: AABB, 2012 (in press).
Karger R, Kretschmer V. Modern concepts of autologous haemotherapy. Transfus
Apher Sci 2005;32:185-96.
National Heart, Lung, and Blood Institute Expert Panel on the Use of Autologous
Blood. Transfusion alert: Use of autologous blood. Transfusion 1995;35:703-11.
Vanderlinde ES, Heal JM, Blumberg N. Autologous transfusion. Br Med J 2002;324:
772-5.
Waters JH, ed. Blood management: Options for better patient care. Bethesda, MD:
AABB Press, 2008.
Waters JH, Cheng D, Shander A, et al, eds. Perioperative blood management: A phy-
sician’s handbook. 2nd ed. Bethesda, MD: AABB/SABM, 2009.
Preoperative Autologous Blood Donation
Etchason J, Petz L, Keeler E, et al. The cost effectiveness of preoperative autologous
blood donations. N Engl J Med 1995;332:719-24.
Thomas MJG, Gillon J, Desmond MJ. Preoperative autologous donation. Transfusion
1996;36:633-9.
Yomtovian R. Practical aspects of preoperative autologous transfusion. Am J Clin
Pathol 1997;107(Suppl 1):S28-S35.
Acute Normovolemic Hemodilution
Jamnicki M, Kocian R, van der Linden P, et al. Acute normovolemic hemodilution:
Physiology, limitations, and clinical use. J Cardiothorac Vasc Anesth 2003;17:747-54.
Monk TG. Acute normovolemic hemodilution. Anesthesiol Clin North America
2005;23:271-81.
AUTOLOGOUS BLOOD 107
Rottman G, Ness PM. Acute normovolemic hemodilution is a legitimate alternative
to allogeneic blood transfusion. Transfusion 1998;38:477-80.
Shander A, Rijhwani TS. Acute normovolemic hemodilution. Transfusion 2004;44:
26S-34S.
Intra- and Postoperative Recovery
Waters JH, Dyga RM, Yazer MA for the Scientific Section Coordinating Committee.
Guidelines for blood recovery and reinfusion in surgery and trauma. Bethesda, MD:
AABB, 2010.
Dai B, Wang L, Djaiani G, et al. Continuous and discontinuous cellwashing auto-
transfusion systems. J Cardiothorac Vasc Anesth 2004;18:210-17.
Hansen E, Bechmann V, Altmeppen J. Intraoperative blood salvage in cancer sur-
gery: Safe and effective? Transfus Apher Sci 2002;27:153-7.
McFarland JG. Perioperative blood transfusions. Indications and options. Chest
1999;115:113S-21S.
Waters JH. Indications and contraindications of cell salvage. Transfusion 2004;44
(Suppl):40S-4S.
Waters JH. Red blood cell recovery and reinfusion. Anesthesiol Clin North Am
2005;23:283-94.
Adverse Reactions
Covin RB, Ambruso DR, England KM, et al. Hypotension and acute pulmonary
insufficiency following transfusion of autologous red blood cells during surgery: A
case report and review of the literature. Transfus Med 2004;14:375-83.
Domen RE. Adverse reactions associated with autologous blood transfusion: Evalua-
tion and incidence at a large academic hospital. Transfusion 1998;38:296-300.
Hansen E, Pawlik E. Reasons against the retransfusion of unwashed wound blood.
Transfusion 2004;44:45S-53S.
Shehata N, Kusano R, Hannach B, Hume H. Reaction rates in allogeneic donors.
Transfus Med 2004;14:327-33.
Trouern-Trend JJ, Cable RG, Badon SJ, et al. A case-controlled multicenter study of
vasovagal reactions in blood donors: Influence of sex, age, donation status, weight,
blood pressure, and pulse. Transfusion 1999;39:316-20.
In: Leonard G, Licata M.
Practical Self-Assessment for Transfusion Medicine Professionals
Bethesda, MD: AABB Press, 2012
10
Erythropoietin, Blood Substitutes, and
Enzymatically Converted Red Cells
QUESTIONS
Question 1: Which of the following statements about erythropoietin (EPO) is true?
A. The main source of EPO in fetal life is the marrow.
B. The plasma EPO level rises linearly as hemoglobin levels decrease below nor-
mal levels ~15 g/dL.
C. Recombinant EPO eliminates the need for supplemental iron.
D. Recombinant EPO takes 3-4 days to elicit a response, so it has no use in the
acute treatment of anemia due to acute hemorrhage.
E. Recombinant EPO facilitates the movement of red cells through plastic tubing.
________________________________ ________________________________
夝
Question 2: Which patient population is LEAST likely to respond to recombinant
EPO?
A. Anemic patients with end-stage renal disease undergoing dialysis 3 times per
week.
B. Anemic patients with anemia of chronic disease secondary to a chronic inflam-
matory condition.
C. Anemic patients with myelodysplastic syndrome.
D. Anemic patients with multiple myeloma.
E. Anemic patients with HIV whose endogenous EPO level is below 500 IU/L.
________________________________ ________________________________
夝
Question 3: Which statement regarding the use of rhEPO in the treatment of anemia
is NOT true?