Blood substitution and complement activation.
Complement activation was studied in 45 patients undergoing total hip arthroplasty under epidural anesthesia. The patients were randomly allocated to three groups. In Group I blood loss was replaced with microaggregate-poor erythrocyte concentrate (SAGM-ERC) plus 3% dextran-60 as plasma substitute, and postoperative analgesia was maintained with intramuscular ketobemidone. In Group II blood loss was replaced as in Group I, but epidural anesthesia was prolonged 12 h postoperatively and kept at a level of T4 with 0.5% bupivacaine. In Group III blood loss was replaced with non-frozen stored plasma plus SAGM-ERC, and postoperative analgesia was maintained with ketobemidone as in Group I. All groups received pre- and postoperative thrombo-prophylaxis with dextran. The plasma concentration of C3a-des-arginine (C3a-desArg) was measured by radioimmunoassay preoperatively, immediately after operation and 3, 6 and 18 h postoperatively. No significant differences in plasma C3 and C4 were found between the groups. C3a-desArg was significantly (P less than 0.01) increased up to 6 h postoperatively in Group III compared with both the preoperative value and Groups I and II. It is demonstrated that infusion of plasma can enhance or initiate endogenous complement activation. Blood component therapy with SAGM-ERC and 3% dextran-60, on the other hand, did not significantly increase the plasma level of C3a-desArg irrespective of the type of postoperative analgesia.
Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Sweden.
U
U
Schött
O
O
Berséus
P
P
Järemo
D000368:Aged; D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D001802:Blood Substitutes / Q000097:blood / Q000494:pharmacology*; D003167:Complement Activation / Q000187:drug effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged
D001802:Blood Substitutes