Leucocyte content in blood processed by autotransfusion devices during open‐heart surgery

Abstract

Autologous red blood cells processed by autotransfusion devices have become increasingly common in major surgery. The finished product, however, often contains varying amounts of leucocytes. We compared leucocyte and their differential counts of blood processed by three autotransfusion devices (Haemonetics Cell Saver IV, Dideco Stat and Dideco Stat-P) during open-heart operations on 25 patients. In addition, a zymosan-induced, luminol-enhanced chemiluminescence method was used to evaluate the activity of neutrophils in prepared autologous blood. High leucocyte counts (3.6-10.9 x 10(9)l-1) were found in all saved red blood cell concentrates. The leucocyte counts of autologous blood produced by the Haemonetics device were lowest (P < 0.01) and about one third of the patients' haematocrit-corrected counts. The proportions of neutrophils were higher in salvaged blood than in the blood circulation before anaesthesia or before retransfusion (P < 0.01). However, no general activation of neutrophils was seen, but the increase in chemiluminescence activity of about 30% that was seen in four patients may suggest an increased risk of reperfusion injury in such patients after aortic declamping. In conclusion, all three autotransfusion devices left leucocytes in the processed red blood cell concentrates, although great differences occurred between the devices.

Leukocyte Activation by means of Intraoperative Blood Salvage

“…In cardiac surgery, Perttilä et al [8] found no statistically significant differences between the PMNL activity (chemiluminescence) measured in IBS concentrate and a baseline measurement of intraoperatively measured patient blood. In 4 out of 10 measurements chemiluminescence in the concentrate was 30% higher than patients' values.…”

Erythrozytenqualität nach maschineller Autotransfusion und Wundblutdrainage

“…flüssigkeit (üblicherweise Kochsalzlö-sung 0,9%) als auch nahezu alle die Produkte, die bei der direkten Drainageblutretransfusion als potentiell schädlich diskutiert werden sowie fast die gesamte Plasmafraktion.Hierzu gehören aktivierte und nicht aktivierte Gerinnungsfaktoren (u.a.Fibrinspaltprodukte,D-Dimere) und Komplementfaktoren, freies Hämo-globin,Produkte der Thrombozytenaktivierung (β-Thromboglobulin,Thromboxan B 2 , Serotonin), Gewebetrümmer, Mikroaggregate, Methylmethacrylatmonomere,Antibiotika,Fett und Knochenfragmente, aber auch Entzündungsmediato-ren wie Zytokine oder PMN-Elastase.Die verschiedenen zur Verfügung stehende Geräte unterscheiden sich in ihren Eliminationsraten von Wundblutbestandteilen nicht grundsätzlich voneinander.Kleinere Unterschiede sollen in der Leukozytenreduktion bestehen [17,26], größere in der Fettelimination [9]. Die Elimination von Plasmabestandteilen (z.…”

“…vorgang nahezu vollständig eliminiert [1,27]. Der Anteil von Leukozyten wird dagegen nur um 50% bis 94% reduziert [17,26]. Problematisch sind diese verbliebenen Leukozyten, weil sie durch den Kontakt mit Fremdoberflächen, durch das mechanische Trauma bei der Absaugung, durch Schaumbildung und die Zentrifugation aktiviert sind.…”

Intraoperative Autotransfusion of RBC and PRP

“…Thus, the RBC concentrate is virtually devoid of any particulate matter, including plasma proteins, coagulation factors and platelets (except for a small, clinically irrelevant fraction of nonfunctional cells and residual heparin) 10,21 . Leukocytes are discharged to a varying degree, depending on the IAT device used 22 . Most of the endogenous compounds released at the operative site and substances introduced by the surgeon are washed out, as well as anticoagulants, antibiotics and other systemically administered drugs 23,25 .…”