Pump-induced platelet aggregation in albumin-coated extracorporeal systems

Borgdorff, Piet; Berg, Rogier H. van den; Vis, M. A.; Bos, G. C. van den; Tangelder, Geert Jan

doi:10.1016/s0022-5223(99)70066-8

Cited by 22 publications

(22 citation statements)

References 26 publications

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“…Consistent with our findings, it was shown that incubation of blood with PVC slides results in rapid binding of leukocytes and platelets (27). Likewise, it is well known that in high-shear applications, in combination with blood activation, platelet deposition appears to be a major concern (24), as the in vitro flow of blood within uncoated tubes causes immediate platelet aggregation and loss (28).…”

Section: Discussionsupporting

confidence: 89%

Preanalytical variability in laboratory testing: influence of the blood drawing technique

Lippi¹,

Salvagno²,

Brocco³

et al. 2005

Clinical Chemistry and Laboratory Medicine (CCLM)

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The predominant technique used to draw blood for laboratory testing is a conventional straight needle attached to an evacuated tube system. However, alternative tools might be advantageous in exceptional circumstances. The use of butterfly devices has been traditionally discouraged for reasons of costs and due to the high risk of obtaining unsuitable samples, but there is no convincing evidence to support the latter indication. The purpose of this study was to compare results of hematological and clinical chemistry testing, after drawing blood into evacuated tubes, employing either a traditional 21-gauge straight needle or a 21-gauge butterfly device with 300-mm-grade polyvinyl chloride tubing. Blood samples and complete sets of data were successfully obtained for 30 consecutive outpatients. Of the 43 hematological and clinical chemistry parameters measured, means for paired samples collected by the two alternative drawing techniques did not differ significantly, except for serum sodium, white blood cells and platelets counts. Bland-Altman plots and limits-of-agreement analysis showed mean bias of between -7.2% and 1.7% and relative coefficients of variation ranging from 0.2% to 21.2%. The 95% agreement interval in the set of differences was acceptable and was mostly within the current analytical quality specifications for desirable bias. The rate of hemolysis in plasma was not statistically different between the two collection techniques. Taken together, the results of the present investigation suggest that, when a proper technique is used and within certain limitations, the butterfly device may be a reliable alternative to the conventional straight needle to draw blood for laboratory testing.

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Section: Discussionsupporting

confidence: 89%

Preanalytical variability in laboratory testing: influence of the blood drawing technique

Lippi¹,

Salvagno²,

Brocco³

et al. 2005

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…By monitoring platelet aggregation continuously, we were recently able to demonstrate that platelets in human and rat blood are activated by use of a roller pump. 16 Furthermore, when a simple coated tube was placed between the proximal part of a carotid artery and the distal part of a femoral artery in rats, pump-induced platelet aggregation was accompanied by systemic hypotension, and both could be prevented with aurintricarboxylic acid. This is a specific inhibitor of shearstress-induced platelet activation that blocks the binding of von Willebrand factor to platelet glycoprotein Ib.…”

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confidence: 99%

Hypotension Caused by Extracorporeal Circulation

2002

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Background-Cardiopulmonary bypass and hemodialysis often cause hypotension. We investigated a possible role of pump-induced platelet activation with consequent serotonin release. Methods and Results-In rats, a heparin-coated extracorporeal shunt was placed between the proximal part of a carotid artery and the distal part of a femoral artery. Autoperfusion did not affect platelets or hemodynamics. Pump perfusion, however, immediately elicited strong platelet aggregation, whereas aortic pressure rapidly fell to 60Ϯ12% (meanϮSD) of its prepump value, partially recovered, and then progressively decreased to 70Ϯ12% at 2 hours. Femoral resistance doubled and then decreased to 59Ϯ11%. The initial changes in aortic pressure and femoral resistance were proportional to the amount of platelet aggregation, were accompanied by a rise (6-fold) in plasma serotonin levels downstream of the pump, but not in the aorta, and could be mimicked by serotonin-infusion into the leg. All hemodynamic changes were prevented or largely reduced by blockade of 5-hydroxytryptamine (5-HT) 2 receptors with pizotifen or ritanserin. The hypotension and femoral resistance decrease could also be prevented or abolished by inhibiting the production of nitric oxide (NO), an intermediate in 5-HT 2B receptor-induced vasodilation. When the extracorporeal blood was pumped into the aortic arch instead of the femoral artery, the hypotensive effect was similar and also NO dependent, but it was absent with venous return. Conclusions-Pump perfusion with arterial return of the blood causes hypotension by endothelial NO-release, which in turn is triggered by serotonin from activated platelets.

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“…PF4 was found to be significantly higher for the test circuits with incubation chamber than for those without the chamber, and further increased when the blood was stressed by high occlusion of the roller pump. The increased activation with high occlusion can be attributed to shear-stressinduced platelet activation, 62 or as a secondary effect to ADP-induced platelet activation as a result of ADP release from lysed erythrocytes. The higher activation of platelets in the incubation setup with incubation chamber is apparently a consequence of the higher surface area in contact with blood and only secondly of the additional shear stress inside the streaming channel.…”

Section: Effect Of Pump Occlusion On Hemolysis and Plateletmentioning

confidence: 99%

“…The formation of PF4 in general was more pronounced in the perfusion chambers, as documented in Figure 14 in comparison to the screening chambers ( Figure 15). The stronger activation of thrombocytes during blood incubation in the perfusion chamber could be due to a shearstress-related thrombocyte activation 62 or related to the release of ADP of shear-stress-destroyed erythrocytes followed by an ADP-induced thrombocyte activation. Correspondingly, more adherent thrombocytes were observed on samples after incubation in the perfusion chambers.…”

Section: Comparison Of Screening and Perfusion Chambersmentioning

confidence: 99%

Design and evaluation of novel blood incubation systems for in vitro hemocompatibility assessment of planar solid surfaces

et al. 2003

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Success in the development of hemocompatible biomaterials depends on adequate equipment and procedures for standardized analysis of blood-materials interactions in vitro. In view of the limited standard of knowledge on that important aspect, two novel incubation systems were designed, built, and evaluated for the in vitro assessment of the hemocompatibility of planar solid surfaces: A screening setup was introduced for the comparison of up to 12 different samples. A perfusion setup was developed to model the directed blood flow in the vascular system during incubation by a recirculation circuit, allowing the variation of the wall shear rate at the sample surface. The incubation procedures utilized freshly drawn, heparinized whole human blood. Hemocompatibility in terms of selected aspects of coagulation, thrombogenicity, and immune responses was quantified through plasma levels of characteristic molecules (immunoassays), cell counting, and analysis of adherent cells and fibrin formation (scanning electron microscopy), respectively. Prevention of blood-air contact and mechanical stress, constant temperature and blood pH during incubation, and the suitable choice of reference materials were found to be crucial for reliable testing. Considering those requirements, screening and perfusion system both provided sensitive discrimination between a given set of planar solid surfaces. In conclusion, the suggested methods for an in vitro hemocompatibility assessment permit versatile, sensitive, and efficient analysis of important blood-material interactions despite the unavoidable variability of blood characteristics in different experiments.

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Pump-induced platelet aggregation in albumin-coated extracorporeal systems

Cited by 22 publications

References 26 publications

Preanalytical variability in laboratory testing: influence of the blood drawing technique

Preanalytical variability in laboratory testing: influence of the blood drawing technique

Hypotension Caused by Extracorporeal Circulation

Design and evaluation of novel blood incubation systems for in vitro hemocompatibility assessment of planar solid surfaces

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