I use packed RBC if the patient needs transfusion. Only 18% of my patients need a blood transfusion. We do thromboelastography (TEG) pre-operatively if patients are on anti platelets and repeat it at the end of surgery. If the patient is bleeding we transfuse products as guided by TEG

We used to use intraoperative hemodilution after induction of anesthesia and before heparinization for years. The most important limitation of this method was units of blood we allowed to take which was mostly confined to one unit. This method was justified in long procedures. Recently, we have switched to retrograde autologous priming (RAP) and it looks like more effective in saving blood and preventing from unnecessary transfusions. Nevertheless, we still do intraoperative hemodilution in patients with high levels of hematocrit and we often aim to avoid HCT levels >30 on CPB. You can find colleague's opinion about RAP here:

https://www.researchgate.net/post/How_often_do_you_use_retrograde_autologous_priming_RAP_in_cardiac_surgery_with_CPB

Studies vary on effectiveness, but in general maybe one unit is spared

Below is a study that failed to find effectiveness:

Anesthesiology. 2002 Aug;97(2):367-73.

Intraoperative low-volume acute normovolemic hemodilution in adult open-heart surgery.

Casati V1, Speziali G, D'Alessandro C, Cianchi C, Antonietta Grasso M, Spagnolo S, Sandrelli L.

Author information 1Division of Cardiac Anesthesia and Intensive Care, and the Division of Cardiac Surgery, Policlinico di Monza, Monza, Italy. [email protected]

Abstract

BACKGROUND: Recently, various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding and the need for allogeneic transfusions in cardiac surgery. The aim of the present study was to reevaluate the effects of a low-volume ANH in elective, adult open-heart surgery.

METHODS: Two hundred four consecutive adult patients undergoing cardiac surgery were prospectively randomized in a nonblinded manner into two groups: ANH group (103 patients), where 5-8 ml/kg of blood was withdrawn before systemic heparinization and replaced with colloid solutions, and a control group, where no hemodilution was performed (101 patients). Procedures included single and multiple valve surgery, aortic root surgery, coronary surgery combined with valve surgery, or partial left ventriculectomy. The purpose of the study was to evaluate the efficacy of ANH in reducing the need for allogeneic blood components. Routine hematochemical evaluations, perioperative blood loss, major complications, and outcomes were also recorded.

RESULTS: No differences were found between the groups regarding demographics, baseline hematochemical data, and operative characteristics. There was no difference in the amount of transfusions of packed red cells, fresh frozen plasma, platelet concentrates, total number of patients transfused (control group, 36% vs. ANH group, 34.3%; P = 0.88), and amount of postoperative bleeding (control group, 412 ml [313-552 ml] vs. ANH group, 374 ml [255-704 ml]) (median [25th-75th percentiles]); P = 0.94. Further, perioperative complications, postoperative hematochemical data, and outcomes were not different.

CONCLUSIONS: In patients undergoing elective open-heart surgery, low-volume ANH showed lack of efficacy in reducing the need for allogeneic transfusions and postoperative bleeding

Dear colleague

Thank you so much for this information. In everyday practice we observed the same effect, but had no evidence to remove this practice from everyday procedure.

Best regards from Moldova.

I had experience in cardiac surgery of predeposit autologous donation.

We performed isovolemic donation, with reposition after donation, but we tried to perfomed erythrocytoaphereis to obtain one or two red cell concentration two or three weeks before cardiac surgery (mostly valvule repair) followed with iron replacement.

We have collected autologous blood after induction in some of our patients. Patients having preoperative hematocrit more than 40 and those without tight LMCA lesion, severe valvular heart disease or unstable hemodynamics are the potential candidates for autologous blood transfusion. In these patients, we start collecting autologous blood after placing the central venous cannulas. Another option is to withdraw blood from a cardioplegia cannula, which would be inserted in the aorta before heparin administration.

A bit off topic, we reported a method of preserving and retransfusing shed whole blood sucked from the wound, in an experimental setting: Scandinavian Cardiovascular Journal, 2010; 44: 177–182. Anecdotally, the method was used once in a patient, but with heparin instead of citrate as anticoagulant. At his time, while I still believe the concept is viable, the equipment has not been developed further to allow clinical use.

In the Update of Seville Consensus Document of Alternatives to transfusion

Recommendation: We suggest the use of preoperative autologous blood donation to reduce transfusion rates in elective cardiac surgical procedures with cardiopulmonary bypass. Grade 2B.

Explanation:

Data from two large observational studies indicate that preoperative donation of two autologous units was the most effective strategy to prevent ABT with lower incremental costs. In some studies, adjuvant treatment with rHuEPO improved the efficacy of PABD in cardiac surgery procedures, both in adults and children.

Dietrich W, Thuermel K, Heyde S, et al. Autologous blood donation in cardiac surgery: reduction of allogeneic blood transfusion and cost-effectiveness. J Cardiothorac Vasc

Anesth 2005; 19: 589-96.

In this same document,

We recommend the use of perioperative red cell salvage to reduce transfusion rates in elective cardiac surgical procedures with cardiopulmonary bypass. Grade 1B.

In cardiac surgery with cardiopulmonary bypass (CPB), salvage, washing and reinfusion of blood from the surgical field, the cardiotomy reservoir and the postoperative chest drainage reduced the percentage of patients exposed to ABT when compared to a control

group, but not the number of ABT units infused per patient. However, PRCS was not effective if it was limited to processing pericardial suction or used in cardiac surgery without CPB.

We have used this technique of autologous blood transfusions in cardiac surgery successfully over the years. It has helped decrease use of blood products and has decreased morbidity.

We have collected autologous blood after induction of anesthesia and before heparinization for years, in some of our patients in adult elective cardiac sugery. This technique has helped decrease use of blood products and is more effective if is associated with  use of perioperative red cell salvage in our experience

 i have been using tautologous blood transfusion since 1997 to date before giving heparin we take one or tow unit then after giving protamin  we transfuse blood back to the patient it is perfect for homeostasis i usually remove all chest tube within 16 hrs and ambulate pt after that