Autotransfusion after open heart surgery: characteristics of shed mediastinal blood and its influence on the plasma proteases in circulating blood.
Fourteen patients undergoing open-heart surgery received intermittent or continuous postoperative autotransfusion of shed mediastinal blood (minimum 400 ml during 6 h after surgery) collected in the cardiotomy reservoir. Hematologic variables and changes in the coagulation, fibrinolytic and plasma kallikrein-kinin systems were investigated in the reservoir blood at the beginning and after 6 h of autotransfusion, and in patient blood during and after surgery and before and after autotransfusion. Autotransfusion volume ranged from 400 to 1200 ml per patient (median 482 ml). The reservoir blood had a median haemoglobin level of 93 and 74 g/l, a platelet count of 71 and 119 x 10(9)/l, and plasma haemoglobin level of 3110 and 4100 mg/l before and after 6 h of autotransfusion, respectively. Further examination of the reservoir blood showed that it had undergone extensive coagulation and fibrinolysis as well as a moderate activation of the kallikrein-kinin system. Despite these extensive alterations in the reservoir blood, no major change could be found in the circulating blood after autotransfusion, except for a moderate increase in plasma haemoglobin from 180 mg/l to 430 mg/l. The clinical safety and simplicity of this technique were confirmed for autotransfusion of shed mediastinal blood up to 1200 ml.
Kongsgaard
U E
UE
Department of Anaesthesiology, Rikshospitalet, Oslo, Norway.
Tølløfsrud
S
S
Brosstad
F
F
Ovrum
E
E
Bjørnskau
L
L
D000368:Aged; D001769:Blood; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures; D010450:Endopeptidases / Q000097:blood*; D006801:Humans; D008482:Mediastinum; D008875:Middle Aged; D011184:Postoperative Period
D010450:Endopeptidases