Processing and transfusion of residual cardiopulmonary bypass volume: effects on haemostasis, complement activation, postoperative blood loss and transfusion volume

Abstract

The aim of this prospective randomized study was to compare the effects of the transfusion of unprocessed and cell saver-processed residual cardiopulmonary bypass (CPB) volume on haemostasis, complement activation, postoperative blood loss and transfusion requirements after elective cardiac surgery. Blood samples were taken at eight points in time, perioperatively. Haematological data, including haemoglobin, haematocrit and platelet counts as well as coagulation parameters, including activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen and the fibrinolytic parameter D-dimers, were measured from each blood sample. For the assessment of complement activation, the total complement CH50 was analysed. In addition, postoperative blood loss and transfusion requirements were measured during the first 24 hours, postoperatively. The results of the study showed impaired haemostasis after the transfusion of both unprocessed and processed CPB volume. No significant differences were found between the groups in the measured coagulation parameters. Nor was a significant difference found in the complement concentration. However, in patients transfused with unprocessed CPB volume, a significantly (p = 0.019) higher amount of blood loss was found, postoperatively. In the same group of patients, the number of units of allogeneic erythrocyte concentrate suspension transfused was also significantly (p = 0.023) higher during the first 24 hours, postoperatively, compared to the patients transfused with processed CPB blood. The number of units of fresh frozen plasma and platelet suspension transfused was not significantly different between the groups. In conclusion, processing CPB volume in combination with processing peroperative blood loss may result in reducing the volume of transfusion needed of allogeneic blood products.

Pump blood processing, salvage and re-transfusion improves hemoglobin levels after coronary artery bypass grafting, but affects coagulative and fibrinolytic systems

“…Moreover, extending cell salvage until 6 hours after the operation does not reduce blood transfusion nor increase hemoglobin levels, while platelet count and fibrinogen levels are significantly reduced 10 . In a prospective randomized study, Daane and coworkers compared the effects of the transfusion of unprocessed and processed residual CBP blood, showing hemostasis alterations after the transfusion in both groups, with no significant differences between the two groups for coagulative parameters and complement factor concentration, but patients receiving unprocessed CPB blood had a significantly higher amount of blood loss and transfusion rates during the first 24 hours 11 . We reported higher postoperative RBC and significantly higher fresh frozen plasma transfusion rates in the cell salvage group despite, in the same group, there being an improvement in hemoglobin levels after processed blood transfusion.…”

Residual blood processing by centrifugation, cell salvage or ultrafiltration in cardiac surgery

“…Although it might be assumed that all three bloodconcentrating techniques improve the RBC fraction of residual blood, direct comparisons of these techniques have only scarcely been described, and most investigations use direct infusion of unprocessed blood as control arm [26]. Wang et al [4] concluded that cell salvage is associated with a reduction in autologous blood products or homologous blood transfusion requirements in patients undergoing cardiac surgery due to a relative gain in RBC volume.…”

Hemostatic function and inflammatory activation after weaning from cardio pulmonary bypass

“…Today there are three methods for transfusion available. Transfusion of unprocessed residual pump blood is often applied 23,157 , washing the blood in a cell saver device before it is transfused are also common and finally retransfusing by the RC-technique which is a common technique in Swedish thoracic centers. There are conflicting theories on the quality of the blood and the opinion varies between surgeons and anesthetists.…”