Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery.
OBJECTIVE
This study was conducted to investigate whether intraoperative blood transfusions affect the release of proinflammatory mediators in patients undergoing cardiac surgery. Therefore, we measured plasma levels of bactericidal permeability increasing protein (BPI) as a marker of neutrophil activation, interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP), and C-reactive protein (CRP). In addition, these mediators, except CRP, were also measured in packed red cell units (PCs) administered to these patients.


METHODS
Prospective study.


METHODS
Cardiopulmonary surgery department in a university hospital.


METHODS
One hundred fourteen consecutive patients undergoing cardiac surgery.


METHODS
Blood samples were taken at induction of anesthesia, at the start of aortic cross-clamping, at aortic unclamping, and at 0.5, 4, 8, and 18 h thereafter.


RESULTS
Thirty-six patients received PC intraoperatively. BPI levels in patients who received transfusions were significantly higher at 0.5 and 4 h after aortic unclamping than in patients without transfusions (p < 0.05), and increased with the number of PC administered. IL-6 levels at 0.5, 4, and 18 h after aortic unclamping were also significantly higher in patients who received transfusions (p < 0.01). BPI was found in all units of packed red cells tested at concentrations up to 15 times preoperative plasma levels in patients. However, PC IL-6 could be detected in none of the samples. Plasma levels of LBP and CRP were similar in both patient groups. LBP was found in very low concentrations in all PC. Patients who received intraoperative transfusions had a worse postoperative performance.


CONCLUSIONS
Intraoperative PC transfusions do contribute to the inflammatory response after cardiac surgery both by enhancing part of the response and by directly changing plasma concentrations of inflammatory mediators. Furthermore, these data show that intraoperative PC transfusion is associated with a worse postoperative performance.
Fransen
E
E
Department of Cardiopulmonary Surgery, University Hospital Maastricht, Maastricht, Netherlands.
Maessen
J
J
Dentener
M
M
Senden
N
N
Buurman
W
W
D000209:Acute-Phase Proteins / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023181:Antimicrobial Cationic Peptides; D001798:Blood Proteins / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D002352:Carrier Proteins / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D017707:Erythrocyte Transfusion; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008562:Membrane Glycoproteins; D008565:Membrane Proteins; D008875:Middle Aged; D018375:Neutrophil Activation; D011446:Prospective Studies; D000099231:Lipopolysaccharide-Binding Protein
D000209:Acute-Phase Proteins; D023181:Antimicrobial Cationic Peptides; D001798:Blood Proteins; D002097:C-Reactive Protein; D002352:Carrier Proteins; D006454:Hemoglobins; D018836:Inflammation Mediators; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D008565:Membrane Proteins; D000099231:Lipopolysaccharide-Binding Protein; C021623:bactericidal permeability increasing protein