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Autotransfusion has not always been a safe procedure. The first known documented procedure of autotransfusion was performed in 1818 by Dr. James Blundell. Dr. Blundell became frustrated by the loss of a patient due to a uterine hemorrhage. Blood transfusions had been attempted for many years before Dr. Blundell, but he was the first to attempt autotransfusion from experimentation with canine specimens. Later he would try his procedure on humans but not without risk. The estimated mortality rate from his procedures was approximately 75%. However, due to modern advancements in filtration and sterile technique, autotransfusion is widely accepted as a relatively safe procedure. This activity reviews the indications and contraindications of autotransfusion and highlights the role of the interprofessional team in managing patients who need autotransfusions. Objectives: Describe the indications for autotransfusion. Review the contraindications to autotransfusion. Summarize the potential complications of autotransfusion. Explain the importance of improving care coordination among the interprofessional team to care for patients needing autotransfusion as a result of bleeding. Access free multiple choice questions on this topic.

Trauma continues to be the predominant cause of death for individuals up to the age of 44 years old.[1] There were a reported 1.2 million deaths due to road traffic crashes in 2018 globally. It has been anticipated that global death rates from road traffic accidents will increase by 67% due to the effects of rapid population growth and industrialization.[2] Despite traumatic brain injury being the leading cause of death from trauma, exsanguination continues to play a significant role. Among patients who arrive at the emergency department with trauma, hemorrhage is the leading cause of death within the first hour. Within the first 24 hours of arrival to the emergency department, nearly 50% of deaths result from hemorrhage.[1] Hemorrhage is the leading cause of both maternal mortality and preventable trauma death worldwide.[3] These deaths could be preventable if the hemorrhage is stopped and lost blood is replaced with blood transfusion. Blood transfusion is an essential part of efficient healthcare and prevents millions of deaths each year. Trauma patients also require a large number of hospital resources and are responsible for using approximately 70% of all blood transfused at a trauma center.[4] Transfusions also place a high burden on the cost of treatment. One study in England found that nearly 12% of their total financial cost was due to transfusions in traumatic patients.[5][6] Transfusion protocols from donated cross-matched blood remain the standard treatment for the hemorrhagic patient, although it is not without risk and has potential adverse side effects. Transfusion of donated blood carries the risk of disease transmission, citrate toxicity, hyperkalemia, hypothermia, hypomagnesemia, acidosis, sepsis, respiratory failure, and thrombotic complications.[7][8][9][10] For these reasons, autotransfusion has widely been known as an alternative or adjunct to cross-matched transfusion therapy with fewer risks.

Transfusion protocols from donated cross-matched blood remain the standard treatment for the hemorrhagic patient, although it is not without risk and has potential adverse side effects. Transfusion of donated blood carries the risk of disease transmission, citrate toxicity, hyperkalemia, hypothermia, hypomagnesemia, acidosis, sepsis, respiratory failure, and thrombotic complications.[7][8][9][10] For these reasons, autotransfusion has widely been known as an alternative or adjunct to cross-matched transfusion therapy with fewer risks. Autotransfusion has not always been a safe procedure. The first known documented procedure of autotransfusion was performed in 1818 by Dr. James Blundell. Dr. Blundell became frustrated by the loss of a patient due to a uterine hemorrhage. Blood transfusions had been attempted for many years before Dr. Blundell, but he was the first to attempt autotransfusion from experimentation with canine specimens. Later he would try his procedure on humans but not without risk. The estimated mortality rate from his procedures was approximately 75%.[11] Due to modern advancements in filtration and sterile technique, autotransfusion is widely accepted as a relatively safe procedure.

The most common complication of autotransfusion is blood loss if not properly connected. A common finding is chest tube placement, in which blood is found to be expressed and then wasted. The more serious complication includes blood contamination resulting in infection.[12][13][21] This issue is avoidable by using a sterile procedure for chest tube placement and careful handling of the lines and equipment. A continuous autotransfusion system can also help reduce the risk of infection, although not readily available in most emergency departments. Other less common complications that merit consideration include hemodilution, hemolysis due to suction or degradation, air embolism, contamination of activated leukocytes, and thrombocytopenia.[12][17] Overall complications are avoidable using sterile technique and if less than 3000 mL of blood is reinfused.

An interprofessional team approach can help achieve the best possible outcomes in some of the highest mortality scenarios. Hemorrhage is the number one cause of death in trauma patients within the first hour, and often cross-matched blood is either not available or painfully delayed. Autotransfusion can provide a segway towards stabilizing the patient and often presents with fewer risks and fewer delays than cross-matched blood. Autotransfusion requires a team approach to ensure the procedure is performed effectively, safely, and with as few complications as possible. This interprofessional team approach includes providers, nursing, and laboratory scientists both in the preparation and execution of the procedure. [Level 5] Before autotransfusion, the following should be in place: Early recognition by providers of the presenting patient that autotransfusion should be utilized Quick preparation from nursing staff of equipment required The sterile technique achieved providing a minimal risk of systemic infection Peripheral access with a blood sample sent to the lab for cross-match and additional laboratory testing if autotransfusion is not possible or insufficient Consultation to surgery if there is an inability to achieve hemostasis