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.
Reents
W
W
Department of Cardiothoracic Surgery, University Hospital, Würzburg, Germany.
Babin-Ebell
J
J
Misoph
M R
MR
Schwarzkopf
A
A
Elert
O
O
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