Case report -autologous transfusion and total thyroidectomy for patient with goitre and thrombocytosis

Introduction: Autologous blood transfusion is the collection of blood from a single patient and re-transfusion back to the same patient when required. The primary driving forces for the use of autologous blood transfusion are to reduce the risk of transmission of infection and to protect an increasingly scarce resource. Case report: A 60 Year old female patient posted for thyroidectomy. On examination solitary swelling in front of the neck of 8*8 cm, oval in shape, smooth surface, extending superiorly upto hyoid bone and inferiorly till suprasternal notch. TFT showed euthyroid state and Blood counts revealed thrombocytosis-7lakhs cu mm. All other investigations were within normal limits. Patient planned for General anaesthesia with nasal intubation(MO<2F). ENT opinion was taken and bilateral vocal cords were reported to be normal.Intraoperative events uneventful. Postoperative subsequent retransfusion of red blood cells along with normal saline was done to preserve adequate blood volume. This technique reduced the platelet count without a significant alteration in coagulation factor activity.Postoperative subsequent retransfusion of red blood cells along with normal saline was done to preserve adequate blood volume. This technique reduced the platelet count without a significant alteration in coagulation factor activity. Discussion: Thrombocytosis is a commonly encountered clinical scenario, with a large proportion of cases discovered incidentally. Thrombocytosis can be spurious, attributed to a reactive process or due to clonal disorder. The threshold for clinically significant thrombocytosis is variable from patient to patient, a platelet count of ≥450 × 109/L is a generally accepted value. ANH is performed in the anaesthetic room shortly after induction of anaesthesia. A large-bore cannula is inserted to allow the collection of 15–20 ml kg−1 of blood prior to surgery. Blood volume is restored with crystalloid or colloid. The collected blood is carefully labelled and kept with the patient in the operating room at all times; there is no need for refrigeration. The blood is transfused back to the patient at the end of surgery once haemostasis is achieved. Conclusion: Autologous blood transfusion, when used appropriately, can provide a safe alternative to allogenic blood transfusion. However, there will always be a need for allogenic blood (even patients who have autologous blood may need further transfusion with allogenic units). There is an important need to balance use of resources in ensuring safe blood transfusion for all those who need it.