Autotransfusion

Blood from the peritoneal cavity can be life-saving, especially when it comes from a ruptured ectopic pregnancy or a ruptured spleen. Also, it carries no risk of hepatitis or HIV, and it will be perfectly cross-matched. Autotransfusion is thus very useful.

Fig. 16-8 AUTOTRANSFUSION using a funnel and a blood-taking set. This is also useful if the patient has a ruptured spleen (66.6). Use large pieces of gauze, and collect the blood in a taking set. Kindly contributed by Stephen Whitehead of Maua Hospital, Kenya.

AUTOTRANSFUSION INDICATIONS. (1) Ectopic pregnancy. (2) Rupture of the spleen (66.6).

CONTRAINDICATIONS. Don't attempt autotransfusion if: (1) There is an offensive smell when you open the patient's abdomen. (2) Her gut has been injured. (3) The blood is obviously haemolysed. (4) She is more than 14 weeks pregnant with a ruptured amniotic sac. Her blood will be contaminated with amniotic fluid containing large quantities of thromboplastin. If you transfuse this, it could theoretically cause DIC (disseminated intravascular coagulation).

CAUTION ! The presence of fresh clots is not a contraindication to autotransfusion.

THE VACUUM BOTTLE METHOD is the best one and allows you to transfuse her before induction (not usually desirable). Buy vacuum bottles, or prepare them by closing blood-taking bottles containing a citrate solution immediately they have been sterilized, before the steam in them has had time to condense (Primary Anaesthesia, Appendix A). Clamp a taking set, introduce one of its needles into her abdomen, as if you were doing a four quadrant tap (66.1), and then put the other needle into the bottle and remove the clamp. To fill the bottle insert another sterile needle connected to a vacuum pump into the bung. You may be able to collect up to 3 litres of blood this way. If the vacuum is imperfect, and does not fill the bottle, apply suction with a vacuum (water) pump connected to a sterile needle inserted through the bung.

THE SOUP LADLE METHOD is less satisfactory, but is useful when you cannot use a vacuum bottle because there are too many clots. Keep the equipment shown in Fig. 16-8 ready sterilized. Put her into a slight Trendelenburg position, make a small opening in her peritoneal cavity to begin with, and be prepared to catch the blood, as it escapes, with a sterilized stainless steel soup ladle or gallipot. Then complete the incision and ladle out the rest of the blood. Her right hypochondrium may be the easiest place to collect it. Pour it through a filter made of 2 or 3 thicknesses of gauze, and collect it in a blood-taking set. The filter in the drip set will remove smaller clots.

Alternatively, you will find a sump useful. This is a conical vessel with a handle and holes towards its tip. Insert it deep in the abdomen; blood will flow in through the holes and can be sucked out.

CAUTION ! (1) Either transfuse the blood immediately, or throw it away. (2) Don't give it to someone else.