Should an anticoagulant be added to autologous blood before reinfusion, and what is the appropriate amount or ratio to use?

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Last updated: June 7, 2026 • View editorial policy

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Anticoagulation for Autologous Blood Re-infusion

Yes, anticoagulant must be added to autologous blood before re-infusion, specifically CPD-A1 (citrate phosphate dextrose-adenine) at a 10% ratio to blood volume.

Specific Anticoagulation Protocol

Based on British Committee for Standards in Haematology guidelines, the standard approach is 1:

For Preoperative Hemodilution (ANH):

  • Use CPD-A1 anticoagulant in licensed blood collection packs
  • Standard ratios: 10% anticoagulant to blood volume
  • Available pack sizes:
    • 450 ml blood packs (with 10% CPD-A1)
    • 250 ml blood packs (with 10% CPD-A1)
  • Critical: Select appropriate pack size to maintain correct anticoagulant-to-blood ratios

For Intraoperative Cell Salvage:

The 2018 Association of Anaesthetists guidelines specify 2:

  • Blood is mixed with anticoagulant during aspiration
  • Two options:
    • Heparinized saline, OR
    • Acid-citrate dextrose (ACD)
  • The anticoagulant is added as blood is aspirated using low-pressure suction into the collection reservoir

Critical Technical Points

During collection 1:

  • The blood pack must be agitated gently throughout collection to ensure proper mixing with anticoagulant
  • This prevents clotting and maintains blood quality
  • Failure to mix adequately will result in clot formation and unusable blood

Important caveat: The type of cell salvage system determines anticoagulation needs:

  • Processed/washed cell salvage: Anticoagulant is added during collection, then red cells are washed and suspended in saline before re-infusion 2
  • Unprocessed salvage (e.g., postoperative cardiac mediastinal drainage): Blood is defibrinated and filtered but not washed 1

Why This Matters for Patient Safety

Without proper anticoagulation:

  • Blood will clot in the collection system, making it unusable
  • Risk of thrombotic complications if clotted material is re-infused
  • Wasted blood that could have reduced allogeneic transfusion needs

The evidence shows autologous transfusion with proper anticoagulation is safe and reduces allogeneic blood requirements 3, but only when anticoagulation protocols are followed correctly.

Bottom line: Never collect autologous blood without anticoagulant. Use CPD-A1 at 10% ratio for ANH, or heparinized saline/ACD for intraoperative cell salvage systems. Follow manufacturer specifications for your specific device.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.