We had a question from anesthesia today concerning removing two units of blood at the beginning of an open heart and reinfusing it at the end of the case. The patient had an elevated Hemoglobin (19) going into surgery.

We decided that two hours before the case started wasn't enough time to begin a new practice, but I promised to investigate the possibility of doing this for future cases.

We don't collect blood products in house and don't want the issues dealing with the FDA. Is there any practical way for surgery to collect a unit or two of blood in bags and then reinfuse the blood at the end of the case.

I am aware that for some surgical procedures that the anaesthetist has venusected a patient once the patient has been anaesthetised for the surgery. That blood collected has then been reinfused before the patient leaves theatre. The laboratory has had no involvement with these patients at all.

Steve

:)

There are many documents and references for intraoperative hemodilution but see as a start:

Stehling L, Zauder HL, Acute normovolemic hemodilution. Transfusion 1991;31(9):857-68.

Although an older article, it contains not only the clinical indications and contraindications but also discusses the technical considerations of performing the procedure, labeling and storage.

They (the OR) should have process/procedure for doing the intraoperative hemodilution . . . it should be reinfused before the patient leaves. YOU DON'T want to receive any product from the OR for either storage or reinfusion later.

They (the OR) should have process/procedure for doing the intraoperative hemodilution . . . it should be reinfused before the patient leaves. YOU DON'T want to receive any product from the OR for either storage or reinfusion later.

100% Agree!! Our OR does have a process for this and we actually have a policy stating that it is the OR's responsibility to own that process, not the labs.

I just wanted to say thanks to everyone for the input, especially the article from transfusion. It's nice to have some positive reinforcement.