[Autotransfusion and plasmapheresis in preparation for surgery. Behavior of coagulation]

Abstract

With the current day implementation of methods of autotransfusion one retransfuses if possible only washed red cell concentrates and eliminates the plasma. In the case of operations where patients undergo large blood loss, one must effect a substitution for the lost plasma volume and the lost clotting factors. In addition to electrolyte and colloidal solutions one can use a substitution of homologous and also autologous fresh frozen plasma (FFP). The effects of different substitutes on the clotting reaction has been investigated in 47 patients on whom extensive orthopaedic and also traumatologic surgical operations have been performed. By the combination of homologous blood and homologous FFP as also with autologous red cells and homologous FFP the clotting reactions remain the same. This determines the advantages of autotransfusion as compared with conventional techniques but, in addition, there is a saving in the usage of homologous blood. Where an operation can be planned in advance, the necessary FFP can be obtained from the patient. By utilisation of autologous FFP the operative and post- operative blood losses are reduced. As a result it is possible e.g. in total hip prosthesis, in approximately 90% of all cases, to operate without using homologous blood or plasma. The determined stability of AT III in autologous plasma--without AT III prophylaxis of thrombosis by Heparin is ineffective--and all other clotting factors leads to an expectancy of a not activated clotting mechanism and at the same time to low thrombosis risks.(ABSTRACT TRUNCATED AT 250 WORDS)