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Autotransfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously "pre-donated" (termed so despite "donation" not typically referring to giving to one's self) before a surgery, or alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device (such as a Cell Saver or CATS). The latter form of autotransfusion is utilized in surgeries where there is expected a large volume blood loss - e.g. aneurysm, total joint replacement, and spinal surgeries. The first documented use of "self-donated" blood was in 1818, and interest in the practice continued until the Second World War, at which point blood supply became less of an issue due to the increased number of blood donors. Later, interest in the procedure returned with concerns about allogenic (separate-donor) transfusions. Autotransfusion is used in a number of orthopedic, trauma, and cardiac cases, amongst others. Where appropriate, it carries certain advantages - including the reduction of infection risk, and the provision of more functional cells not subjected to the significant storage durations common among banked allogenic (separate-donor) blood products. ==History== There is some evidence that in 1785 Philip Physic of Philadelphia transfused a post-partum patient. However the first documented use of autologous blood transfusion was in 1818 when an Englishman, Blundell, salvaged vaginal blood from patients with postpartum hemorrhage. By swabbing the blood from the bleeding site and rinsing the swabs with saline, he found that he could re-infuse the result of the washings. This unsophisticated method resulted in a 75% mortality rate, but it marked the start of autologous blood transfusion. During the American Civil War Union Army physicians are said to have administered four transfusions. In 1886, J. Duncan used autotransfusion during the amputation of limbs by removing blood from the amputated limb and returning it to the patient by femoral injection. This method was apparently fairly successful. A German, M. J. Theis, reported the first successful use of intraoperative autotransfusion in 1914, with a ruptured ectopic pregnancy. The earliest report in the American literature on the use of autotransfusion was by Lockwood in 1917 who used the technique during a splenectomy for Banti syndrome. Interest in the unrefined technique of autotransfusion continued through to the early 1940s, and was applied to various procedures including treatment of ectopic pregnancy hemothorax, ruptured spleen, perforating abdominal injuries, and neurosurgical procedures. The interest in autotransfusion dwindled during World War II, when there was a large pool of donors. After the war, blood testing, typing, and crossmatching techniques were improved making blood banks the answer to the increased demand for blood. In the 1960s, interest in autotransfusion revived. With the advances in all fields of surgery, new companies developed autotransfusion devices. Problems still arose, however, with air embolism, coagulopathy, and hemolysis.〔Nicholson E, 1988, Autolgous blood transfusion, Nurs Times, 13-19; 84(2):33-5 Jan 1988〕 The devices used during the Korean and Vietnam War collected and provided gross filtration of blood before it was reinfused.〔Autologous Blood Transfusion Education Program, Training Manual, Shiley Incorporated, Irvine CA, 1992〕 With the introduction of cardiopulmonary bypass in 1952, autotransfusion became an area of study. Klebanoff began a new era of autotransfusion by developing the first commercially available autotransfusion unit in 1968. His system, the Bentley Autotransfusion System aspirated, collected, filtered and reinfused autologous whole blood shed from the operative field. The problems with the Bentley system included the requirement of systemic anticoagulation of the patient, introduction of air embolism, and renal failure resulting from unfiltered particulate in the reinfused blood. As the Bentley system lost favor Wilson and associates proposed the use of a discontinuous flow centrifuge process for autotransfusion which would wash the red cells with normal saline solution. In 1976, this system was introduced by Haemonetics Corp. and is known commonly as "Cell Saver". More recently in 1995 Fresenius introduced a continuous autotransfusion system.〔() Fresenius〕 There are three types of systems: un-washed filtered blood; discontinuous flow centrifugal; and continuous flow centrifugal. The unwashed systems are popular because of their perceived inexpense and simplicity. However unwashed systems can cause increase potential for clinical complications. The washed system requires a properly trained and clinically skilled operator. It returns only red blood cells suspended in saline and is rarely associated with any clinical complications. Discontinuous autotransfusion can practically eliminate the need for exposure to homologous blood in elective surgical patients and can greatly reduce the risk of exposure to emergency surgical patients. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Autotransfusion」の詳細全文を読む スポンサード リンク
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