A trial of fresh autologous whole blood to treat dilutional coagulopathy following cardiopulmonary bypass in infants.
BACKGROUND
Transfusion of fresh whole blood is superior to blood component therapy in correcting coagulopathies in children following cardiopulmonary bypass (CPB); however, a supply of fresh homologous whole blood is difficult to maintain. We hypothesized that transfusion of fresh autologous whole blood obtained prior to heparinization for CPB and infused following CPB would be associated with improved coagulation function when compared with standard therapy.


METHODS
A total of 32 infants 5-12 kg undergoing noncomplex open cardiac surgery were randomly assigned to either the treatment or control group. In the treatment group, 15 ml x kg(-1) of autologous whole blood was collected into a CPDA bag prior to heparinization while 15 ml x kg(-1) of 5% albumin was infused intravenously. After reversal of heparin, coagulation tests were drawn in both groups, and the autologous whole blood was infused over 20 min in the treatment group.


RESULTS
The treatment group had greater (P < 0.05) improvement in platelet count, prothrombin time, and fibrinogen than the control group.


CONCLUSIONS
We conclude that collection of fresh autologous whole blood prior to heparinization and reinfusion following CPB is associated with greater improvement of coagulation status after CPB in infants.
Friesen
Robert H
RH
Department of Anesthesiology, The Children's Hospital and the University of Colorado School of Medcine, Denver, CO 80218, USA. friesen.robert@tchden.org
Perryman
Kathy M
KM
Weigers
Kim R
KR
Mitchell
Max B
MB
Friesen
Richard M
RM
D000925:Anticoagulants / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000628:therapy*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D005340:Fibrinogen / Q000032:analysis / Q000378:metabolism; D006438:Hemodilution / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D010976:Platelet Count; D011183:Postoperative Complications / Q000628:therapy*; D011517:Prothrombin Time; D016896:Treatment Outcome
D000925:Anticoagulants; D005340:Fibrinogen; D006493:Heparin