Fibrinolytic activity and postoperative salvaged untreated blood for autologous transfusion in major orthopaedic surgery.
OBJECTIVE
To evaluate the fibrinolytic activity in a closed surgical wound, in postoperatively drained blood, and during autologous transfusion.


METHODS
Prospective study.


METHODS
National hospital, Norway.


METHODS
9 patients operated on for thoracic scoliosis.


METHODS
Concentrations of plasmin/antiplasmin (PAP), alpha2-antiplasmin, and D-dimers in drained, arterial, and mixed venous blood before, during, and after infusion of 10 ml/kg body weight of postoperatively drained, untreated blood.


RESULTS
In drained blood the concentration of alpha2-antiplasmin was 31% of the preoperative arterial control value. Together with the increased concentrations of PAP to 18076 microg/L and D-dimers to 126 mg/L, this indicates extensive fibrinolytic activity in the closed wound. The postoperative autologous transfusion of drained, untreated blood increased the concentration of PAP from 507 to 2453 microg/L and of D-dimer from 0.7 mg/L to 15.3 mg/L in systemic blood.


CONCLUSIONS
The systemic concentration of fibrin(ogen) degradation products, indicated by D-dimers, after recirculation of drained, untreated blood might impair coagulation. The extensive activation of plasmin might exhaust available alpha2-antiplasmin in the wound and result in postoperative rebleeding.
Krohn
C D
CD
National Hospital, Centre for Orthopaedics, Oslo, Norway.
Reikerås
O
O
Bjørnsen
S
S
Brosstad
F
F
D000293:Adolescent; D000328:Adult; D000933:Antifibrinolytic Agents; D001804:Blood Transfusion, Autologous; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005341:Fibrinolysin / Q000032:analysis; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D011446:Prospective Studies; D012600:Scoliosis / Q000601:surgery; D014945:Wound Healing / Q000502:physiology*; D000979:alpha-2-Antiplasmin / Q000032:analysis
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; D000979:alpha-2-Antiplasmin; C036309:fibrin fragment D; C037742:plasmin-plasmin inhibitor complex; D005341:Fibrinolysin