title: Circulating non-hematological cells during cardiopulmonary bypass: new findings in cardiac surgery procedures.
abstract: BACKGROUND
  Several factors have been historically advocated to explain the coagulative and inflammatory disorders following cardiopulmonary bypass (CPB). In this paper, we describe the presence of circulating non-hematological cells, introduced within the bloodstream during CPB. We defined the origin of the cells and tested their impact on coagulation.
  
  
  METHODS
  We collected peripheral arterial blood samples in twenty consecutive coronary artery bypass graft cases at four different surgical moments and assessed the presence and nature of circulating cells with the use of the CELLSEARCH® Test, immunocytochemistry and immunofluorescence, evaluating the expression of cytokeratin and calretinin. The effect of the circulating non-hematological cells on coagulation was tested in vitro, using the ROTEM assay.
  
  
  RESULTS
  A mean of 263.85 ± 57.5 (median 258.5) cells were present in the samples following the suction of blood from the surgical field while all the other samples were negative (zero cells) (p<0.00001). Immunologic tests confirmed the mesothelial origin of the cells. The ROTEM® assay of the blood samples contaminated by the mesothelial cells presented longer clotting times (53.4 ± 8.2 secs 48.3 ± 8.9 sec, p=0.05), longer clot formation times (137.1 ± 31.5 sec vs 111.9 ± 25.2 sec, p=0.009), smaller alfa angle amplitudes (66.7 ± 9.1° vs 71.1 ± 5.1°, p=0.04) and maximum clot firmness times (59.0 ± 5.4 sec vs 61.9 ±4.6 sec, p=0.004) than the controls.
  
  
  CONCLUSIONS
  The presence of circulating non-hematological cells during CPB with a mesothelial immunophenotype alters in vitro coagulation assays. This finding can help to further understand the pathophysiology of CPB.
authors.affiliation: Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy gianlucasantise@yahoo.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Santise
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marinaro
authors.affiliation: Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.affiliation: Cardiothoracic Surgery Unit, Sant'Anna Hospital, Catanzaro, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Dominici
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Di Vito
authors.affiliation: Department of Health Science, Pathology Unit, University of Catanzaro, "Magna Graecia", Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Donato
authors.affiliation: Department of Health Science, Pathology Unit, University of Catanzaro, "Magna Graecia", Catanzaro, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Camastra
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Italy.
authors.forename: Pio
authors.initials: P
authors.lastname: Zeppa
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Barni
authors.affiliation: Department of Medical Surgery Science, University of Catanzaro, "Magna, Graecia", Catanzaro, Italy.
authors.forename: Antonia
authors.initials: A
authors.lastname: Rizzuto
authors.affiliation: Department of Clinical and Experimental Medicine, University of Catanzaro, "Magna Graecia", Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viglietto
authors.affiliation: Department of Health Science, Pathology Unit, University of Catanzaro, "Magna Graecia", Catanzaro, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mignogna
mesh_terms: D000368:Aged; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D064032:Calbindin 2 / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D004847:Epithelial Cells / Q000166:cytology* / Q000473:pathology; D005260:Female; D006801:Humans; D018189:Immunomagnetic Separation; D007633:Keratins / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013916:Thrombelastography
chemical_list: D064032:Calbindin 2; D007633:Keratins
keywords: CPB; embolism (microvascular, circulating non-hematological cells); inflammatory response; pathophysiology