Perioperative autotransfusion and its correlation to hemostasis and coagulopathies

The use of autologous blood techniques affords the reduction or elimination of homologous blood transfusions for most patients. In addition, for certain religious faiths such as Jehovah's Witnesses or those patients with rare blood types, intraoperative salvage and return of the patient's own blood is the only source of available blood. Autologous blood salvage in the perioperative period includes: hemodilution; intraoperative salvage of lost blood; postoperative collection of shed blood. Perioperatively, autologous blood is salvaged and returned and the volumes involved do not create any hematological problems for the patient. In those cases involving large volumes of blood being processed and returned to the patient, the autotransfusionist must be aware of the possible alterations that may occur in the patient's coagulation system. The collection and reinfusion of wound drainage fluids from operative sites has the potential to cause severe bleeding problems. This paper will present an overview of autologous blood salvage techniques in the perioperative period along with a review of the clinical effects of autotransfusion on hemostasis. Also discussed will be possible coagulopathies that can be caused by returning collected autologous blood.