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phine was effective treatment in the majority of cases because of the slow absorption of opium. Mechanical ventilation was required in twelve cases (6%) only. There were three deaths; two of these were due to pulmonary oedema which was apparently not the result of hypoxia. Refererices 1. BORDBAR, A. & TABIBZADEH, A. (1973) Acute opium poisoning. Journal of the Iranian Medical Council, 3, 189. 2. ECKENHOFF, J.E., ELDER,J.D. & KING,B.D. (1952) N-allyl-normorphine in the treatment of morphine or demerol narcosis. American Journal of Medical Sciences, 223, 191. 3. BRITISH PHARMACEUTICAL CODEX (1968) Opium, p. 555. The Pharmaceutical Press, London. 4. WOOD-SMITH, F.G., VICKERS,M.D. & STEWART, H.C. (1973) Drugs in anaesthetic practice, 4th edn. Butterworths, London. 5. LOWENSTEIN, E., HOLLOWELL, P., LEVINE, F.H., DOGGEIT, W.M., AUSTEN, W.G. & LAVER, M.B. (1969) Cardiovascular response to large doses of intravenous morphine in man. New England Journal of Medicine, 281, 1389. R.B. (1973) Cardiovascular effects of heroin in the 6. BRASHEAR, R.E., CORNOG, J.L. & FORNEY, dog. Anaesthesia and Analgesia: Current Researches, 52, 323. W.G. (1970) Pulmonary complications of drug 7. BRETTNER, A., HEITZMAN, E.R. & WOODIN, therapy. Radiology, 96, 31. 8. MORRISON, W.J., WETHERILL, S. & ZYROFF, J. (1970) Acute pulmonary edema in heroin intoxication. Radiology, 97, 347. 9. SIEGEL, H. (1972) Human pulmonary pathology associated with narcotic and other addictive drugs. Human Pathology, 3,55. 10. STEINBERG, A.D. & KARLINER, J.S. (1968) The clinical spectrum of heroin pulmonary oedema. Archives of Internal Medicine, 122, 127. 11. SILBER, R., POLERKIN, E.P. (1959) Pulmonary oedema in acute heroin poisoning. Report of four cases. American Journal of Medicine, 27, 187. 12. CONN,H.F. (1972) Current Therapy, p. 857. Saunders, Philadelphia, U.S.A. M. (1974) A comparative study of the narcotic 13. EVANS, J.M., Hocc, M.I.J., LUNN,J.N. & ROSEN, agonist activity of naloxone and levallorphan. Anaesthesia, 29, 721.
Twenty-two cases of autotransfusion H . Maleki, M D , Assistant Professor, A . Bordbar M D , D A (England), Headof Department, and N. Fateh, M D , Clinical Assistant, Department of Anaesthesia, Faculty of Medicine, Esfahan University, Iran Autotransfusion is a procedure in which the blood lost by a patient is subsequently returned to his circulation. -6 The practice of autogenous blood transfusion is based on several premises; no blood is amore perfect match for a person than his own, bleeding is a stimulus to blood formation, the normal erythopoietic system is endowed with high functional reserves and transmission of disease from one person to another is eliminated by the procedure. These fundamental concepts have been applied to twenty-two cases in the authors’ practice in the last 8 years during which time twenty cases of ruptured ectopic pregnancy and two cases of traumatic haemothorax due to knife wounds were given their own blood which had been collected from the peritoneal or thoracic cavities. Technique
The abdomen or thorax was opened by the surgeon in the usual way. Swabs were not used
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to remove the blood; if it appeared fresh and was normal in colour, it was aspirated into a sterile bowl by means of a 50 ml syringe; this was done very slowly to reduce haemolysis. The blood was then transferred through a blood taking set into avacuum transfusion bottle containing acid citrate dextrose as an anticoagulant. The blood was transfused to the patient immediately. Bentley filters were used on two occasions but, in all the other cases, a double transfusion set was employed to remove any small clots which might have been present, (Fig. 1)
Investigations
Samples of blood from the peritoneal or thoracic cavities were sent for culture in all cases. Blood samples were also taken from the peritoneal or thoracic cavities and from the bowl to be tested for haemolysis in all cases. The haemoglobin levels of the patient before and 4 days after autotransfusion and the haemoglobin level of the blood in the abdomen or chest were also measured in six cases. Results
There was no evidence of bacterial contamination or of haemolysis and there were no other complications or deaths. The various haemoglobins and the amounts of blood transfused in the six cases investigated are recorded in Table 1. Discussion
This procedure has a life-saving value in difficult environments and small hospitals in which emergency surgery must be carried out in circumstances where there are no blood bank facilities or haematological technicians or when there is no blood of the right group or not enough of it available.’-* It will also save patient charges for the blood bank and blood grouping in countries where these are levied.
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Table 1. Autotransfusion haemoglobin levels and amounts
Transfusion Site
Haemoglobin levels (mg/lOOml) Amount
Autotransfused blood
Patient Before
Abdomen Abdomen Abdomen Abdomen Thorax Thorax
2.50 1.50 2.25 2.50* 2.00 1.50
13.50 12.0 12.0 11.0 14.0 13.0
4 days after
8.0 9.0 6.0 5.0 8.0 9.0
12.0 12.0 11.5 12-o* 14-0 13.0
* 1.0 Litres of donor blood was also given in this case. It should also be remembered that donor transfusion carries appreciable These include the transmission of viral hepatitis and other diseases which may be transported by donor transfusion including malaria and syphilis. Much can therefore be said in favour of autotransfusion. If it is carried out carefully, it is a very safe procedure and it is applicable to other emergency cases besides those already mentioned including splenic rupture and major arterial trauma. Summary Twenty cases of ruptured ectopic pregnancy and two cases of haemothorax which have been given autotransfusion by a simple technique are reported. No deaths or complications occurred. The advantages of autotransfusion particularly in circumstances where laboratory facilities are minimal are discussed. Haemoglobin levels before and after transfusion and other investigations are recorded.
References L. VASQUEZ, E., PEREZ, V. & RAFFUCCI, F.L. (1966) Autologous blood transfusion in card1 . CUELLO, diovascular surgery. Boletin de la Association Medica de Puerto Rico, 58,93. H.T., MILLES, G. & DALESSANDRO, W. (1963) Further experiences with autogenous blood 2. LANGSTON, transfusion. Annals ofsurgery, 158,333. 3. WILSON,J.D. & TAWELL, H.F. (1968) Autotransfusion: historical review and preliminary report on a new method. Mayo Clinic Proceedings, 43,26. D.H., DIORIO,D.A., STONE,H.H. & SYMBAS, P.N. (1973) Autotransfusion of intraperitoneal 4. TYRAS, blood: an experimental study. The American Surgeon, 39, 652. J.G., CLARKE, A.D. &JACKSON, P.W. (1972) Reduction of blood loss by restoration 5. WAGSTAFFE, of platelet levels using fresh autologous blood transfusion after cardiopulmonary bypass. Thorax, 27,410. U.N. & STEWART, D.B. (1970) Autotransfusion in ruptured ectopic pregnancy. Lancet, i, 6, PATHAK, 961. 7. HOSSAINI, A.A. & BOYAN,C.P. (1972) Transfusion reactions. International Anesthesiology Clinics, 10,127. P.L. (1972) Clinical Medicine, 5th edn. p. 9. Blackwell Scientific Publications, Oxford. 8. MOLLISON,
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phine was effective treatment in the majority of cases because of the slow absorption of opium. Mechanical ventilation was required in twelve cases (6%) only. There were three deaths; two of these were due to pulmonary oedema which was apparently not the result of hypoxia. Refererices 1. BORDBAR, A. & TABIBZADEH, A. (1973) Acute opium poisoning. Journal of the Iranian Medical Council, 3, 189. 2. ECKENHOFF, J.E., ELDER,J.D. & KING,B.D. (1952) N-allyl-normorphine in the treatment of morphine or demerol narcosis. American Journal of Medical Sciences, 223, 191. 3. BRITISH PHARMACEUTICAL CODEX (1968) Opium, p. 555. The Pharmaceutical Press, London. 4. WOOD-SMITH, F.G., VICKERS,M.D. & STEWART, H.C. (1973) Drugs in anaesthetic practice, 4th edn. Butterworths, London. 5. LOWENSTEIN, E., HOLLOWELL, P., LEVINE, F.H., DOGGEIT, W.M., AUSTEN, W.G. & LAVER, M.B. (1969) Cardiovascular response to large doses of intravenous morphine in man. New England Journal of Medicine, 281, 1389. R.B. (1973) Cardiovascular effects of heroin in the 6. BRASHEAR, R.E., CORNOG, J.L. & FORNEY, dog. Anaesthesia and Analgesia: Current Researches, 52, 323. W.G. (1970) Pulmonary complications of drug 7. BRETTNER, A., HEITZMAN, E.R. & WOODIN, therapy. Radiology, 96, 31. 8. MORRISON, W.J., WETHERILL, S. & ZYROFF, J. (1970) Acute pulmonary edema in heroin intoxication. Radiology, 97, 347. 9. SIEGEL, H. (1972) Human pulmonary pathology associated with narcotic and other addictive drugs. Human Pathology, 3,55. 10. STEINBERG, A.D. & KARLINER, J.S. (1968) The clinical spectrum of heroin pulmonary oedema. Archives of Internal Medicine, 122, 127. 11. SILBER, R., POLERKIN, E.P. (1959) Pulmonary oedema in acute heroin poisoning. Report of four cases. American Journal of Medicine, 27, 187. 12. CONN,H.F. (1972) Current Therapy, p. 857. Saunders, Philadelphia, U.S.A. M. (1974) A comparative study of the narcotic 13. EVANS, J.M., Hocc, M.I.J., LUNN,J.N. & ROSEN, agonist activity of naloxone and levallorphan. Anaesthesia, 29, 721.
Twenty-two cases of autotransfusion H . Maleki, M D , Assistant Professor, A . Bordbar M D , D A (England), Headof Department, and N. Fateh, M D , Clinical Assistant, Department of Anaesthesia, Faculty of Medicine, Esfahan University, Iran Autotransfusion is a procedure in which the blood lost by a patient is subsequently returned to his circulation. -6 The practice of autogenous blood transfusion is based on several premises; no blood is amore perfect match for a person than his own, bleeding is a stimulus to blood formation, the normal erythopoietic system is endowed with high functional reserves and transmission of disease from one person to another is eliminated by the procedure. These fundamental concepts have been applied to twenty-two cases in the authors’ practice in the last 8 years during which time twenty cases of ruptured ectopic pregnancy and two cases of traumatic haemothorax due to knife wounds were given their own blood which had been collected from the peritoneal or thoracic cavities. Technique
The abdomen or thorax was opened by the surgeon in the usual way. Swabs were not used
228
Forum
to remove the blood; if it appeared fresh and was normal in colour, it was aspirated into a sterile bowl by means of a 50 ml syringe; this was done very slowly to reduce haemolysis. The blood was then transferred through a blood taking set into avacuum transfusion bottle containing acid citrate dextrose as an anticoagulant. The blood was transfused to the patient immediately. Bentley filters were used on two occasions but, in all the other cases, a double transfusion set was employed to remove any small clots which might have been present, (Fig. 1)
Investigations
Samples of blood from the peritoneal or thoracic cavities were sent for culture in all cases. Blood samples were also taken from the peritoneal or thoracic cavities and from the bowl to be tested for haemolysis in all cases. The haemoglobin levels of the patient before and 4 days after autotransfusion and the haemoglobin level of the blood in the abdomen or chest were also measured in six cases. Results
There was no evidence of bacterial contamination or of haemolysis and there were no other complications or deaths. The various haemoglobins and the amounts of blood transfused in the six cases investigated are recorded in Table 1. Discussion
This procedure has a life-saving value in difficult environments and small hospitals in which emergency surgery must be carried out in circumstances where there are no blood bank facilities or haematological technicians or when there is no blood of the right group or not enough of it available.’-* It will also save patient charges for the blood bank and blood grouping in countries where these are levied.
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Table 1. Autotransfusion haemoglobin levels and amounts
Transfusion Site
Haemoglobin levels (mg/lOOml) Amount
Autotransfused blood
Patient Before
Abdomen Abdomen Abdomen Abdomen Thorax Thorax
2.50 1.50 2.25 2.50* 2.00 1.50
13.50 12.0 12.0 11.0 14.0 13.0
4 days after
8.0 9.0 6.0 5.0 8.0 9.0
12.0 12.0 11.5 12-o* 14-0 13.0
* 1.0 Litres of donor blood was also given in this case. It should also be remembered that donor transfusion carries appreciable These include the transmission of viral hepatitis and other diseases which may be transported by donor transfusion including malaria and syphilis. Much can therefore be said in favour of autotransfusion. If it is carried out carefully, it is a very safe procedure and it is applicable to other emergency cases besides those already mentioned including splenic rupture and major arterial trauma. Summary Twenty cases of ruptured ectopic pregnancy and two cases of haemothorax which have been given autotransfusion by a simple technique are reported. No deaths or complications occurred. The advantages of autotransfusion particularly in circumstances where laboratory facilities are minimal are discussed. Haemoglobin levels before and after transfusion and other investigations are recorded.
References L. VASQUEZ, E., PEREZ, V. & RAFFUCCI, F.L. (1966) Autologous blood transfusion in card1 . CUELLO, diovascular surgery. Boletin de la Association Medica de Puerto Rico, 58,93. H.T., MILLES, G. & DALESSANDRO, W. (1963) Further experiences with autogenous blood 2. LANGSTON, transfusion. Annals ofsurgery, 158,333. 3. WILSON,J.D. & TAWELL, H.F. (1968) Autotransfusion: historical review and preliminary report on a new method. Mayo Clinic Proceedings, 43,26. D.H., DIORIO,D.A., STONE,H.H. & SYMBAS, P.N. (1973) Autotransfusion of intraperitoneal 4. TYRAS, blood: an experimental study. The American Surgeon, 39, 652. J.G., CLARKE, A.D. &JACKSON, P.W. (1972) Reduction of blood loss by restoration 5. WAGSTAFFE, of platelet levels using fresh autologous blood transfusion after cardiopulmonary bypass. Thorax, 27,410. U.N. & STEWART, D.B. (1970) Autotransfusion in ruptured ectopic pregnancy. Lancet, i, 6, PATHAK, 961. 7. HOSSAINI, A.A. & BOYAN,C.P. (1972) Transfusion reactions. International Anesthesiology Clinics, 10,127. P.L. (1972) Clinical Medicine, 5th edn. p. 9. Blackwell Scientific Publications, Oxford. 8. MOLLISON,
