[Autotransfusion after cardiac surgery. Hematological, biochemical and immunological properties of shed mediastinal blood].
OBJECTIVE
Although it is well documented that the reinfusion of unwashed shed blood reduces postoperative homologous blood requirements after cardiac surgery, the efficacy and safety of the technique has been questioned on the basis of several possible adverse effects. We therefore aimed to evaluate the extent of mediastinal shed blood damage by cardiopulmonary bypass (CPB) and extravasation.


METHODS
Five perioperative blood samples were obtained from each of the 20 patients undergoing cardiac surgery: by venipuncture, during the induction of anesthesia (sample 1), at the end of CPB (sample 2), and one hour after mediastinal shed blood reinfusion (sample 5), and from the cardiotomy reservoir at the first and sixth postoperative hours (samples 3 and 4). Hematological, biochemical and immunological parameters, and the metabolic and functional status of shed erythrocytes were studied in each sample.


RESULTS
Hematological and biochemical values were lower at the end of CPB and in shed blood, but not after reinfusion. Inversely, plasma free hemoglobin levels and echinocyte formation were elevated after CPB and in shed blood, the latter correlating with the decrease in serum albumin levels due to hemodilution. No alterations were detected in erythrocyte median corpuscular fragility, D-glucose, L-phenylalanine and L-serine uptakes or 2,3-bisphosphoglycerate content. Plasma IL-10 levels were elevated at the end of CPB, whereas shed blood showed increased levels of IL-1beta, IL-6 and IL-10. Shed blood retrieval did not modify the pattern of circulating cytokines found at the end of CPB.


CONCLUSIONS
Shed mediastinal blood salvaged after cardiac surgery seems to be an excellent source of red cells, which conserve functional and metabolic status; once reinfused, shed blood does not modify the inflammatory response of the patient to CPB.
Salas Millán
J
J
Servicios de Cirugía Cardiovascular, Anestesiología y Reanimación, Málaga.
de Vega
N
N
Carmona Aurioles
J
J
Negri Arjona
S
S
García-Vallejo
J
J
Muñoz Gómez
M
M
D001772:Blood Cell Count; D001786:Blood Glucose / Q000032:analysis; D001798:Blood Proteins / Q000032:analysis; D001804:Blood Transfusion, Autologous / Q000295:instrumentation; D002469:Cell Separation / Q000295:instrumentation*; D001026:Coronary Artery Bypass; D016207:Cytokines / Q000097:blood; D017707:Erythrocyte Transfusion / Q000295:instrumentation / Q000379:methods*; D004912:Erythrocytes / Q000378:metabolism; D005112:Extracorporeal Circulation; D005260:Female; D005374:Filtration; D019918:Heart Valve Prosthesis Implantation; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007378:Interleukins / Q000097:blood; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009996:Osmotic Fragility; D011182:Postoperative Care / Q000295:instrumentation / Q000379:methods*; D012709:Serum Albumin / Q000032:analysis; D013396:Suction / Q000295:instrumentation
D001786:Blood Glucose; D001798:Blood Proteins; D016207:Cytokines; D006454:Hemoglobins; D007378:Interleukins; D012709:Serum Albumin