title: Intraoperative use of platelet-plasmapheresis in vascular surgery.
abstract: OBJECTIVE
  To determine, in a pilot study, whether pheresis of plasma and platelets before surgical blood loss, with reinfusion of the autologous plasma and platelets after completion of the aortic reconstruction, will result in decreased bleeding and decreased transfusion of allogenic blood components in patients undergoing elective aortic reconstruction.
  
  
  METHODS
  Randomized study.
  
  
  METHODS
  University medical center.
  
  
  METHODS
  Patients were randomized to perioperative (acute) platelet plasmapheresis (APP group) versus conventional blood component therapy (control group). In the APP group, blood was withdrawn after induction of anesthesia, to sequester approximately 300 mL of platelet rich plasma (PRP); platelet poor plasma (PPP) and red blood cells (RBC) were sequestered as well. An autotransfusion device was used to collect and re-infuse autologous RBC during the course of the operation in both groups. After completion of the aortic reconstruction, autologous PRP and PPP were re-infused in the APP group. Blood loss, volume of blood component transfusions, and preoperative and postoperative hemoglobin (Hb), hematocrit (Hct), platelet, international normalized ratio (INR), and activated partial thromboplastin time (aPTT) were recorded.
  
  
  RESULTS
  There was no difference between groups in demographics, preoperative laboratory values, or surgical procedures, although more patients were treated for aneurysms (73% vs. 60%) and fewer for occlusive disease (20% vs. 40%) in the control versus APP group. Also, there were no differences between the control and APP groups in duration of operation, blood loss, volume of colloid infused, or volume of allogenic RBC and plasma transfused. Patients in the APP group received a greater volume of crystalloid solution (9.1 +/- 3.4 L vs. 6.8 +/- 3.0 L; p = 0.002), but fewer units of allogenic platelets than the control group (0.7 +/- 1.0 units vs. 0.2 +/- 0.4 units; p < 0.04). There were no differences in postoperative Hb, Hct, INR, aPTT, or fibrinogen. The platelet count was lower in the APP group than in the control group (123 +/- 40 x 10(3)/mm(3) vs. 182 +/- 51 x 10(3)/mm(3); p = 0.004).
  
  
  CONCLUSIONS
  Perioperative platelet plasmapheresis led to fewer allogenic platelet transfusions in patients undergoing elective aortic reconstruction. However, there was no decrease in blood loss and no reduction in transfusion of allogenic RBC or plasma. Perioperative platelet plasmapheresis is not recommended for routine use in elective aortic reconstruction.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of California, Davis School of Medicine, Davis, CA, USA.
authors.forename: Amira M
authors.initials: AM
authors.lastname: Safwat
authors.forename: Ruth
authors.initials: R
authors.lastname: Bush
authors.forename: William
authors.initials: W
authors.lastname: Prevec
authors.forename: John A
authors.initials: JA
authors.lastname: Reitan
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001777:Blood Coagulation; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D010314:Partial Thromboplastin Time; D010949:Plasma; D010952:Plasma Substitutes / Q000008:administration & dosage; D010956:Plasmapheresis; D010976:Platelet Count; D017713:Platelet Transfusion; D010983:Plateletpheresis; D011446:Prospective Studies
chemical_list: D006454:Hemoglobins; D010952:Plasma Substitutes