[Effective autotransfusion thanks to cooperation]

A 61-year-old female patient scheduled for major vascular surgery had several diseases, including cardiovascular, pulmonary, renal and hepatic insufficiency. Prior operations--major vascular surgery, strumectomy--had led in most cases to severe bleeding complications owing to a known inherited thrombopathia. Therefore, it was questionable whether an operation would be possible at all. Coordination of three medical departments (vascular surgery, anesthesiology and hematology) created an individual transfusion program. Over a period of 6 weeks, autologous blood was collected in the Anesthesiology Department by means of the so-called leap-frog technique, resulting in the availability of 4 units of autologous packed cells plus 9 units of autologous fresh frozen plasma by the day of surgery. During the operation we used a Shiley autotransfusion device (Autotrans). Two days before the preoperation substitution with homologous thrombocytes was started (one highly concentrated unit per day). This was continued until the 4th postoperative day. Operative procedure performed included reconstruction of iliac artery, bilateral profunda plastic and iliac-femoral cross-over bypass grafting. Only autologous blood products were utilized; apart from thrombocytes no further homologous derivatives were required. The patient had a normal recovery period with no episodes of bleeding or hematoma. There was no need for a long hospital stay. The case presented stresses the importance of good cooperation between physicians for successful treatment of our patients in general and effective use of autotransfusion in particular.