Both preoperative blood donation and acute normovolemic hemodilution involve collecting the patient’s own blood preoperatively. (See “Autologous blood collection, preoperative,” page 41.) In contrast, in perioperative autologous blood transfusion, blood is collected during or after surgery.¹ This perioperative blood donation (sometimes called intraoperative or postoperative) is used in the treatment of traumatic injury as well as during vascular and orthopedic surgery because considerable bleeding may follow these surgeries. Blood may be collected during surgery or up to 12 hours afterward in a process called red blood cell (RBC) salvage.

Blood collected during surgery undergoes a process in which RBCs are washed and packed and then transfused immediately. (See Autologous blood recovery systems.) Blood obtained postoperatively may be collected from chest tubes, mediastinal drains, or wound drains that are placed in the surgical wound during surgery with devices such as the Solcotrans autotransfusion system or Pleur-evac drains for blood recovery. Blood recovered postoperatively from wound drains is typically filtered, and the total volume is infused into the patient with an approximate hematocrit of 30%. Blood collected postoperatively must be reinfused within 6 hours of being collected because of the increased risk of infection.² Blood collected intraoperatively may be used for 6 to 8 hours. Check you facility’s policy for specifics.

Contraindications for perioperative autologous transfusion are the same as for preoperative autologous transfusions. Intraoperative collection devices may also cause problems if they’re used improperly. The blood units returned to the patient may be overdiluted during the washing process, or the units may not be washed well, exposing the patient to the anticoagulant medications that were used to keep the blood from clotting in the collection container as well as to other debris that may have been suctioned from the surgical wound.