The Influences of Red Blood Cell Transfusion on Perioperative Inflammatory Responses Using a Miniaturized Biocompatible Bypass With an Asanguineous Prime

Abstract

SummaryWhole blood transfusion generates an inflammatory response and may contribute to organ dysfunction following cardiopulmonary bypass. We established a miniaturized (minimum 140 mL) and biocompatible bypass system to reduce perioperative inflammatory responses and avoid blood transfusions. This study was designed to reveal the influences of stored red blood cell (RBC) transfusions on perioperative inflammatory responses in infants.Fifty-four consecutive patients weighing 4-10 kg who underwent surgical procedures for complex heart anomalies with asanguineous prime were retrospectively reviewed. Twenty-two patients (40.7%) received RBC transfusions during CPB. The postoperative peak white blood cell count (p-WBC), peak neutrophil count (p-NC), and peak C-reactive protein (p-CRP) were compared for both patient groups. Stepwise multiple logistic regression analyses were used to investigate which of the factors most affected the perioperative inflammatory responses.The p-CRP and p-NC in patients with transfusion was significantly greater than those in patients without transfusion (CRP 8.1 ± 5.1 versus 5.5 ± 3.0 mg/dL, P < 0.05, p-NC 14.6 ± 4.5 versus 12.0 ± 4.0 × 1000/mm 3 , P < 0.05). Multivariate analyses showed that RBC transfusion most affected p-WBC (coefficient: 3.89, 95% confidence interval [CI] 0.79-6.99, P = 0.015) and p-NC (coefficient: 3.64, 95% CI 0.87-6.40, P = 0.011). The RBC transfusions increased the perioperative inflammatory responses, compared to transfusion-free procedures, even when using a miniaturized biocompatible bypass with an asanguineous prime. (Int Heart J 2009; 50: 581-589)

Rejuvenation improves roller pump–induced physical stress resistance of fresh and stored red blood cells

“…Although the retrospective nature of these studies does not allow for a definitive conclusion about the safety of older RBCs, these reports have focused the attention on the RBC aging process and on the potential of RBC‐mediated mechanisms to be detrimental to the transfusion recipients. Some of the retrospective studies that do not favor stored RBCs have involved cardiac bypass surgery and may represent a unique subset of patients and/or conditions for the stored RBCs 14 . In this patient group, the blood goes through additional physical stresses produced by the rollers of the cardiac bypass pumps, which could lead to release of RBC fragments and Hb and thus affect oxygen delivery 15 .…”

Minimizing intraoperative hemodilution by use of a very low priming volume cardiopulmonary bypass in neonates with transposition of the great arteries

“…However, also neonates receiving blood transfusion in the ICU may profit from the blood-free completion of CPB because reduction of priming volume has been shown to ameliorate the inflammatory response to pediatric cardiac surgery independently from blood transfusion. 19,20 In addition, the minimized CPB circuits also reduce dilution of platelets and plasmatic coagulation factors that may result in better preservation of the hemostatic system. 9 Pivotal for these results is the CPB circuit presented here, which is unique as compared with the circuits discussed above by its very low priming volume of 95 to 110 mL while maintaining the standard safety features such as arterial line filter.…”

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“…Because the use of old blood as the prime solution (12 days >) rises the lactate levels and causes tissue hypoxia development [18]. Also, to reduce perioperative inflammation, leukocyte-free blood transfusion is recommended [19].…”