title: The influences of red blood cell transfusion on perioperative inflammatory responses using a miniaturized biocompatible bypass with an asanguineous prime.
abstract: Whole blood transfusion generates an inflammatory response and may contribute to organ dysfunction following cardiopulmonary bypass. We established a miniaturized (minimum 140 mL) and biocompatible bypass system to reduce perioperative inflammatory responses and avoid blood transfusions. This study was designed to reveal the influences of stored red blood cell (RBC) transfusions on perioperative inflammatory responses in infants. Fifty-four consecutive patients weighing 4-10 kg who underwent surgical procedures for complex heart anomalies with asanguineous prime were retrospectively reviewed. Twenty-two patients (40.7%) received RBC transfusions during CPB. The postoperative peak white blood cell count (p-WBC), peak neutrophil count (p-NC), and peak C-reactive protein (p-CRP) were compared for both patient groups. Stepwise multiple logistic regression analyses were used to investigate which of the factors most affected the perioperative inflammatory responses. The p-CRP and p-NC in patients with transfusion was significantly greater than those in patients without transfusion (CRP 8.1 +/- 5.1 versus 5.5 +/- 3.0 mg/dL, P < 0.05, p-NC 14.6 +/- 4.5 versus 12.0 +/- 4.0 x 1000/mm3, P < 0.05). Multivariate analyses showed that RBC transfusion most affected p-WBC (coefficient: 3.89, 95% confidence interval [CI] 0.79-6.99, P = 0.015) and p-NC (coefficient: 3.64, 95% CI 0.87-6.40, P = 0.011). The RBC transfusions increased the perioperative inflammatory responses, compared to transfusion-free procedures, even when using a miniaturized biocompatible bypass with an asanguineous prime.
authors.affiliation: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors.forename: Kagami
authors.initials: K
authors.lastname: Miyaji
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kohira
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Inoue
authors.forename: Kei-ichi
authors.initials: K
authors.lastname: Itatani
authors.forename: Hajime
authors.initials: H
authors.lastname: Sato
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Ohara
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D002675:Child, Preschool; D004867:Equipment Design; D017707:Erythrocyte Transfusion; D005112:Extracorporeal Circulation / Q000295:instrumentation; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D008904:Miniaturization / Q000295:instrumentation; D015999:Multivariate Analysis; D009504:Neutrophils; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein