Influence of different autotransfusion devices on the quality of salvaged blood.
BACKGROUND
Cardiopulmonary bypass causes a systemic inflammatory response and impaired hemostasis. We investigated whether intraoperative blood salvage with the cardiotomy suction contributes to these alterations. Furthermore, an alternative autotransfusion device (Haemonetics cell-saving device) was examined.


METHODS
In 10 patients, interleukin-6, interleukin-8, tumor necrosis factor-alpha, thrombin-antithrombin complex, plasmin-antiplasmin complex, free hemoglobin, and the percentage of CD62+ thrombocytes were determined in the systemic circulation during cardiopulmonary bypass, in the cardiotomy suction tube, and in the blood from the cell-saving device. Additionally, bacterial contamination was examined.


RESULTS
Median levels of interleukin-6 (52 versus 10 microg/L; p = 0.005), interleukin-8 (26 versus 20 microg/L; p = 0.017), tumor necrosis factor-alpha (24 versus 1 microg/L; p = 0.005), thrombin-antithrombin complex (113 versus 43 microg/L; p = 0.005), plasmin-antiplasmin complex (566 versus 489 microg/L; p = 0.022), and free hemoglobin (61 versus 30 mg/dL; p = 0.005) were higher in the cardiotomy suction tube compared with the systemic circulation. After processing the blood from the cell-saving device, interleukin-8, thrombin-antithrombin complex, and free hemoglobin remained above reference range, and in 90% of the cases bacterial contamination was observed.


CONCLUSIONS
Cardiotomy suction additionally contributes to the release of proinflammatory cytokines, activation of coagulation, and hemolysis. Because blood salvage with a Haemonetics cell-saving device led to normalization of some, but not all, parameters and bacterial contamination was common, the alternative use seems at least questionable.
Department of Cardiothoracic Surgery, University Hospital, Würzburg, Germany.
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W
Reents
J
J
Babin-Ebell
M R
MR
Misoph
A
A
Schwarzkopf
O
O
Elert
D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000032:analysis; D000990:Antithrombin III / Q000032:analysis; D001021:Aortic Valve / Q000601:surgery; D001419:Bacteria / Q000254:growth & development; D001769:Blood / Q000382:microbiology; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000295:instrumentation*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005341:Fibrinolysin / Q000032:analysis; D006400:Hematocrit; D006487:Hemostasis; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007432:Intraoperative Period; D007958:Leukocyte Count; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis; D010976:Platelet Count; D013396:Suction / Q000295:instrumentation; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D000979:alpha-2-Antiplasmin
D000933:Antifibrinolytic Agents; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C037742:plasmin-plasmin inhibitor complex; D000990:Antithrombin III; D010447:Peptide Hydrolases; D005341:Fibrinolysin