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This procedure is well known, there were 2 000 cases reported in the literature with a very small number of complications. Is autotransfusion really efficacious? According to the author's results in 9 cases of hemoperitoneum, the red cells obtained by this method are quantitatively valid, but hemolysis starts early (6 hours) and the disappearance of the platelets and coagulation factors occurs even more early (2 hours). However, clinical tolerance is perfect, thus confirming the good experimental results obtained in animals. The true limits are hemolysis and the risk of contamination but, with appropriate apparatus and precise indications, and unsoiled blood, less than 24 hours old, autotransfusion is a good method which may provide a solution in certain emergencies.

Acute normovolemic hemodilution was performed in 46 pts. before major surgical procedures 1800 ml of pt's blood were withdrawn and hct. lowered to 24.8% mean. The hct. after retransfusion averaged 31.8% while homologous blood could widely be avoided. 78% of pts tolerated a.n.h. well or sufficiently. During a.n.h. circulatory parameters remained constant while CO rose from 4.4 to 6.1 1/min. Shortly after a.n.h., in 13 cases slight, in 10 cases, however, severe side reactions occurred: rise in BP, HR and PAP, peripheral vasoconstriction with decrease of peripheral blood flow, unproportional increase of CO and ST-depression in ECG. As a reason of this centralisation reaction a sympathetic reaction and hypoxia are discussed.

Many factors already contribute to limit the amount of bank blood available for therapeutic use; a possible reduction in the amount of available blood could stem from the relative indifference of young people towards the gift of blood and the increase in the size of the pool of positive carriers of Australian antigen. Moreover, new operations appear (coronary by-pass) which increase the demand for blood. It is imperative that we adopt attitudes and practice techniques that will contribute to the conservation of blood. This paper discusses the advantages of an active blood bank committee which, alone, can reduce the consumption of blood by 20 percent. Moreover, actual techniques for conservation of blood are reviewed: controlled hypotension, haemodilution and intraoperative blood salvage.

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.

To determine the toxic effect of whole blood and hemoglobin on the retina, volumes of autogenous blood varying between 0.3 and 1.5 ml and various hemoglobin concentrations were injected intravitreally into speciosa monkeys. Electroretinograms were performed at the outset of the experiment and immediately before sacrifice. After six weeks the animals were killed and the eyes were processed for histologic and electron microscopic examination. Three intravitreal injections of 0.3 ml of autogenous blood administered at one-month intervals or one injection of 22.4 mg of hemoglobin did not produce a toxic effect on the retina demonstrable by light or electron microscopic examination or electroretinography. Intravitreal injection of more than 0.6 ml of whole blood or 40 mg of hemoglobin produced definite toxic effects histologically and electroretinographically. The damage found histologically correlated well with the degree of hemosiderin deposition. Explosive lesions produced by xenon are photocoagulation to induce moderate vitreous hemorrhage failed to produce toxic doses of blood within the eye. In humans undergoing vitrectomy to remove vitreous hemorrhage, the amount of whole blood recovered from vitrectomy fluid was considered nontoxic, except when the patient had massive vitreous hemorrhage or intraoperative bleeding.