title: The effects on coagulation of the reinfusion of unprocessed residual blood from the cardiopulmonary bypass.
abstract: BACKGROUND
  Autologous blood transfusion is a common technique in cardiac surgery to directly re-infuse residual blood from the cardiopulmonary bypass (CPB) circuit to the patient. The objective of this study was to evaluate the effects of reinfusion of unprocessed residual pump blood on the coagulation system after separation from the CPB circuit and reversal of systemic heparin with protamine.
  
  
  RESULTS
  After ethics approval, 40 participants undergoing cardiac surgery were recruited in a prospective single center cohort study. Changes in coagulation were assessed with standard plasma based laboratory assays and thromboelastography. After the reinfusion of unprocessed residual pump blood there were decreases in the mean aPTT (effect size 6 s; SD: 6.05; p < 0.0001) and thrombin time (effect size 4.08 s; SD: 9.7; p = 0.01). There were no significant changes in PT, INR and D-dimer. Post reinfusion there were increases in fibrinogen, hemoglobin and platelet counts. There were improvements in the R-time (effect size 9.1 s; SD: 16.9; p = 0.0023), K-time (effect size 1.5 s; SD: 3.6 s; p = 0.0017), alpha angle (6.9°; SD: 15.8; p = 0.012), and maximum amplitude (3.0 mm; SD: 5.6, p = 0.002) on thromboelastography.
  
  
  CONCLUSIONS
  The reinfusion of unprocessed residual CPB blood resulted in no deleterious effects on the coagulation system measured by both the common laboratory plasma based measurements of coagulation and thromboelastography.
authors: Department of Cardiac Surgery, Austin Hospital, Heidelberg, VIC, Australia. yolandeiyer@gmail.com.
authors: Yolande-Leigh
authors: YL
authors: Iyer
authors: Department of Cardiac Surgery, Austin Hospital, Heidelberg, VIC, Australia. philip.hayward@austin.org.au.|Department of Surgery, University of Melbourne, Parkville, VIC, Australia. philip.hayward@austin.org.au.
authors: Philip
authors: P
authors: Hayward
authors: Department of Surgery, University of Melbourne, Parkville, VIC, Australia. larry.mcnicol@austin.org.au.|Department of Anaesthesia, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia. larry.mcnicol@austin.org.au.
authors: Larry
authors: L
authors: McNicol
authors: Department of Anaesthesia, Austin Hospital, Studley Road, Heidelberg, VIC, 3084, Australia. laurence.weinberg@austin.org.au.|Department of Surgery and Centre for Anaesthesia, Perioperative and Pain Medicine, University of Melbourne, Parkville, VIC, Australia. laurence.weinberg@austin.org.au.
authors: Laurence
authors: L
authors: Weinberg
mesh_terms: D001777:Blood Coagulation; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013916:Thrombelastography; D016896:Treatment Outcome