What is blood transfusion?
Blood transfusion is the process by which blood is given intravenously, to replace blood that has been lost through surgery, or trauma, or as a result of a medical requirement.

What is the purpose of blood transfusion?
Blood is a complex substance responsible for transportation, regulation and protection in the human body through a network of arteries, capillaries and veins. All of the functions are important but too numerous to be listed here. However, worth a mention is how blood provides oxygen to the tissues. Blood loss is coupled with the body's decreased capacity to deliver oxygen. Patients can feel exhaustion, even at rest.

Your blood allows oxygen to be delivered to your body’s tissues and organs and for waste products, such as carbon dioxide, to be removed and discarded. This process is essential for tissue survival and function and for recovery after surgery. The purpose of a blood transfusion, is amongst other things, to replace lost blood, and to help ensure that oxygen transportation and transfer continues to be carried out effectively by the body.

What are the most common blood transfusion options?
Donor / Banked blood (also known as Homologous or Allogenic blood)
The most common method of performing blood transfusion in the UK today is by using ‘donor’ blood. This is blood that has been collected by public donation, processed and then stored under controlled conditions until it is required for transfusion to a different recipient.
The processing performed on this type of blood includes screening for blood borne diseases such as HIV and Hepatitis B and is, therefore, generally regarded as a safe and effective method of transfusion.

To make sure the correct blood type is given, the Donor blood is "cross-matched" with the recipient. This ensures that no severe reactions occur on transfusion. However, errors, although very rare, are known to have occurred in the past (1)

Autologous Blood Transfusion or ABT (sometimes referred to as Autotransfusion)
There is another, safer, option that can be used for some operations. This option is known as Autologous Blood Transfusion, or ABT for short, and is the name given to the process through which the patient's own blood is re-infused by transfusion. Blood can be taken from a patient either during the surgical procedure itself (Intra-operative collection), or, after surgery (Post-operative collection).

Autologous transfusion is particularly suitable if you are scheduled to go into hospital for non-emergency surgery, and have the opportunity to decide in advance to have your own blood re-infused. This may be the case, for example, with total knee and total hip replacement surgery. For total knee replacement surgery, post-operative collection is particularly appropriate as the majority of blood loss occurs after completion of the operation.

“Post operative ABT can only be used in certain orthopaedic procedures such as Total Knee Replacements but offers multiple benefits. It reduces the risk of people receiving the wrong blood, minimises adverse reaction, limits the demand on blood-bank stocks and the equipment involved is uncomplicated and easy to use.”

What are the BENEFITS to patients of having their own blood back?

Getting your own blood back (Autologous Blood Transfusion) is considered to be safer than using banked blood because the risk of transmission of diseases and infections is significantly reduced.

It is possible that you may experience reactions to donor blood as some of the blood constituents may be identified as harmful by your biological defence mechanisms. The body’s immune system may act to protect you against these foreign constituents. The process by which this occurs is similar to the process that starts after identification of the presence of an unwanted bacteria or virus. The likelihood of such reactions occuring is dramatically reduced when using your own blood.

Research has also shown that having your own blood returned to you may improve post-operative response and diminish the risk of infection (2). It may also help to reduce the length of your stay in hospital (2).

Importantly, as well as gaining the personal benefits of having your own blood as opposed to banked blood, this technique, used in the appropriate surgery, may eradicate the need to use any banked blood at all. Many users have found that they do not even need to cross match. Reducing these types of activities saves resources which is increasingly more important to the NHS. It also means that the UK’s precious blood stocks are reserved for types of treatment or patients for whom autologous blood is not appropriate. So, receiving a unit of your own blood, where possible, could be as important as donating a unit of blood for the blood banks!

In some cases, donor blood transfusion is refused on the grounds of religious beliefs, for example, with Jehovah’s Witness patients. Although the use of ABT (Autologous Blood Transfusion) is very much reliant on the individual’s belief and choice under these circumstances, the techniques are widely accepted by Jehovah’s Witness groups as a potential solution. This subject can be studied in further detail by logging on to www.watchtower.org (the official website of Jehovah’s Witnesses).

Further benefits to society
Autologous Blood Transfusion techniques have been used for over a decade in some UK hospitals and are widely available in many countries, including the USA. The Department of Health is now directing hospitals within the NHS to implement processes aimed at more appropriate use of blood due to the growing cost of banked blood and the implications of blood shortages that could arise as a result of the massive strain on the currently available stocks. The use of ABT is forming a significant and important part of this process.

FREQUENTLY ASKED QUESTIONS

Q1: What is the benefit of receiving back my own blood rather than having bank blood?
A: Autologous transfusion is generally considered to be safer than using bank blood because it reduces the risk of the transmission of blood-borne disease and infection such as HIV. Research has shown that having your own blood returned to you following surgery may improve post-operative response, diminish the risk of side effects and may also help to reduce the length of your stay in hospital. (2)

Q2: When can I elect to have my own blood back?
A: During or after some procedures you may be able to have your own blood back. However, you must seek guidance from your medical adviser on whether it is appropriate in your case.

Q3: How does the process of receiving back my own blood work?
A: You can get your blood back in two ways – Intra-operative collection (this is when your blood is collected and given back during your operation) and Post-operative (when your blood is collected and given back after your operation).

The process of reinfusing the blood works in the same way as it would with banked blood. A needle (cannula) will be inserted into your arm to allow the blood to re-enter the body. This is not too painful (similar to having a blood sample taken).

Q4: What is Post-operative Autologous Blood Transfusion and how does it work?
A: During Post-operative Autologous Transfusion, your blood is collected and re-infused after the operation. Once collected (using a wound drain placed at the site of the procedure) your blood will then be filtered and reinfused back into your body. This is particularly relevant in TKR (Total Knee Replacement) as the majority of the blood loss occurs after the operation.

Intra-operative Autologous Transfusion (IOC) is when blood is collected from a patient during an operation. Blood is collected during surgery, ‘washed’ and then collected into a bag for reinfusion. This process all happens whilst you are asleep and undergoing the surgery so you would not know anything about the collection. Usually, the blood is returned to you whilst you are in surgery.

Q5: Why haven’t I heard about this form of blood transfusion before?
A: Autologous blood transfusion is not a new form of blood transfusion. It is a tried, trusted and safe method of transfusing blood. It has been used for over a decade in some UK hospitals, and is widely available in many countries, including the USA. However, in the UK, the NHS has traditionally performed blood transfusions using mostly donated blood.

The Department of Health is now directing hospitals within the NHS to offer patients autologous blood transfusions where appropriate, as it recognises the advantages to the patient and the NHS of using this form of blood transfusion.

Q6: I have heard the phrase Autotransfusion, what is this?
A: Autotransfusion is an alternative word for autologous transfusion.

Q7: Will having autologous blood transfusion affect my treatment or recovery?
A: Having a post-operative autologous blood transfusion should not affect the way in which the procedure is performed. In addition it may actually speed up your recovery (2). Having back your own blood reduces the risk of suffering a reaction to the transfusion, which can happen when having a blood transfusion using donated blood.

Q8: Who do I speak to, to gain more advice on receiving a post-operative autologous blood transfusion and to find out if my hospital provides this transfusion method?
A: If you are going into hospital for a hip or knee replacement, there are a number of people to discuss post-operative autologous blood transfusion with, namely:

* Your General Practitioner (GP)
* Hospital Patients' Advocate
* The Pre-admissions Nurse dealing with your operation
* The Consultant in charge of the procedure
* Visit the Hospital Information Centre
It is important to note however that specific procedures for individual patients can vary widely and the guidance of your medical advisers, who are in the best position to address any concerns or questions you may have, should always be paramount in any decision concerning your treatment.

If you are a Jehovah's Witness, you can contact your local Hospital Liaison Committee for more advice. Your local hospital will aid you with this process.

Q9: When should I let my hospital know that I want to have an autologous blood transfusion?
A: You should make it clear at the earliest opportunity to everyone involved in your procedure that you would like to consider having an autologous blood transfusion.

Q10: What should I do if I want my own blood back, but my hospital does not make the autologous blood transfusion option available?
A: You must seek advice from the hospital’s Patient Advocate who will be based at the hospital you are visiting. Ensure you do this prior to being admitted for your operation.

Q11: Are there any reasons why I cannot have my own blood back?
A: In certain circumstances you may not be able to have an autologous blood transfusion. Reasons can include underlying medical conditions, health and type of procedure taking place.

When considering an autologous blood transfusion you must seek guidance from those people within the hospital who will be treating you and providing consultation.

Q12: Are there any risks of my blood being infected through an autologous blood transfusion?
A: Your blood is collected at the bedside following the operation and is reinfused without the need for additional screening. Therefore the risks of infection are minimal. In addition the risk of incorrect blood type being given is eliminated.

Q13: Do I need to prepare anything in order to receive Post- operative Autologous Blood?
A: There are no special requirements for receiving post-operative autologous blood. Your consultant will tell you if it is an option that suits your medical situation.

Q14: Will I need to operate any equipment when having Post-operative Autologous Blood reinfused?
A: No. The nurse who will be looking after you will be fully trained to operate the equipment that collects your blood. Reinfusion of post-operative autologous blood is handled in the same strict way as donated blood.

Q15: Can Post-operative Autologous Blood be used for every knee, hip and spinal surgery?
A: In certain circumstances you may be unable to have post-operative autologous blood. This may be due to medical conditions, health, types of procedure etc. at the time of the operation.

You must seek guidance from your medical adviser on whether it is applicable for your operation at the time of consultation.

Q16: Will I need to have bank blood if I have autologous blood?
A: In some cases there will still be a need to use bank blood for a blood transfusion. You must seek guidance from your medical adviser on whether it is applicable for your operation at the time of consultation.

If bank blood does need to be used, then the amount needed will generally be significantly less than if you did not initially receive post-operative autologous blood.