Reinfusion of autologous platelet-rich plasma improves hemostasis after cardiopulmonary bypass]

Although it is reported that postoperative bleeding is reduced by reinfusing autologous platelet-rich plasma (PRP) after cardiopulmonary bypass (CPB), the effect of PRP on hemostasis is not reported in detail. We prepared PRP and fresh whole blood (WB) from the blood of seven patients each prior to their undergoing CPB, and reinfused them autologously to the patients intravenously after the CPB was terminated. In this article, the effect on hemostasis of autologous PRP and WB was described. Platelet aggregation rates and blood coagulation factors were examined before, during and after bypass. Platelet counts, ADP-induced platelet aggregation and the activities of coagulation factors II, V and VII-X were significantly greater in prepared PRP than in WB (p less than 0.01 or p less than 0.05). A mean volume of 724 +/- 109 ml of PRP or 401 +/- 63 ml of WB was reinfused within about 30 minutes after heparin was neutralized by protamine sulfate. The platelet counts increased from 4.3 +/- 1.4 x 10(4)/mm3 to 14.1 +/- 1.6 x 10(4)/mm3 after PRP reinfusion and the platelet aggregation rates increased significantly (p less than 0.01) after PRP reinfusion compared to WB transfusion. The activities of coagulation factors VII-X also increased significantly (p less than 0.05) after reinfusion of PRP when compared to transfusion of WB. The activated partial thromboplastin time decreased to 1.2 times the baseline in the PRP group but remained 1.5 times the baseline in the WB group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

A prospective, randomized platelet-function study of heparinized oxygenators and cardiotomy suction

OBJECTIVE: The purpose of this study was to determine if substitution of a heparin-coated oxygenator and salvaged autologous blood for cardiotomy suction would improve platelet function. DESIGN: A prospective, randomized trial. SETTING: A large academic medical center. PARTICIPANTS: Sixty adult patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass (CPB). INTERVENTIONS: Patients were randomized into 1 of 4 groups in a 2 x 2 factorial design by oxygenator (heparinized v nonheparinized) and blood salvage during CPB (cardiotomy suction v salvaged autologous blood). MEASUREMENTS AND MAIN RESULTS: Primary outcome measures were platelet function, glass-bead retention, platelet dense-body adenosine triphosphate secretion, platelet-rich plasma (PRP) aggregometry, Plateletworks platelet-function analyzer (Helena Laboratories Corp, Allen Park, MI), and platelet count. Secondary outcome measures were chest-tube drainage and allogeneic blood transfusion requirements. All platelet-function tests except thrombin-receptor activator peptide-induced PRP aggregometry showed a reduction in platelet function during and immediately after CPB (all p < 0.05). The only statistically significant difference in platelet-function tests between the groups was the glass-bead assay at 5 minutes before discontinuation of CPB (p < 0.05). This difference resolved 10 minutes after protamine administration. There were no differences between the groups in the amount of blood transfused, chest-tube drainage, and routine laboratory test results. CONCLUSIONS: The authors concluded that the effects of these changes to the CPB circuit were small and inconsequential in this cohort of patients.     

A prospective, randomized study of cardiopulmonary bypass temperature and blood transfusion

BACKGROUND: We hypothesized that normothermic cardiopulmonary bypass (CPB) would be associated with decreased blood loss and allogeneic transfusion requirements relative to hypothermic CPB. METHODS: After obtaining institutional review board approval and informed patient consent, we conducted a prospective, randomized study of 79 patients undergoing CPB for a primary cardiac operation at normothermic (37 degrees C) (n = 44) or hypothermic temperature (25 degrees C) (n = 35). Blood loss and transfusion requirements in the operating room and for the first 24 hours in the intensive care unit were determined. A paired t test and rank sum tests were used. A p value of less than 0.05 was considered significant. RESULTS: The normothermic and hypothermic CPB groups did not differ in demographic variables, CPB or cross-clamp duration, heparin sodium or protamine sulfate dose, prothrombin time, or thromboelastogram results. There were no differences between the two CPB groups in blood loss or transfusion requirements. CONCLUSIONS: We found that when there was no difference in duration of CPB, normothermic and hypothermic CPB groups demonstrated similar blood loss and transfusion requirements even though other studies have shown hypothermia induces platelet dysfunction and alters the activity of the coagulation cascade.     

Preoperative plateletpheresis does not reduce blood loss during cardiac surgery

Acute preoperative plateletpheresis has been reported to be effective in reducing blood loss and blood component transfusion while improving haematological profiles in patients undergoing open-heart surgery. However, in these studies, the concomitant use of cell saver techniques may have been responsible for the beneficial effects because they remove free haemoglobin and activated procoagulants and, therefore, could mask the deleterious effects of combined plateletpheresis and cardiopulmonary bypass (CPE). In the present study, 40 patients undergoing primary myocardial revascularization were randomly divided into two groups: a control group without plateletpheresis performed, and a second group in which preoperative platelet-rich plasma 10 ml · kg^?1 (PRP group) was collected and later reinfused after reversal of heparin. Standardized surgery, anaesthesia and CPB without concomitant cell saver techniques were employed. In the PRP group, blood transfusion was reduced (1.5 ± 1.3 vs 2.4 ± 1.3 units, P < 0.05) but this was accompanied by lower postoperative haemoglobin concentrations. There were no differences in blood loss (992.6 ± 327.4 vs 889.6 ± 343.7 ml), fresh frozen plasma (2/19 vs 3/20 patients) or platelet requirements (1/19 vs 1 /20 patients). Reinfusion of autologous PRP did not improve platelet count and function, nor tests of coagulation. Fibrinogen concentrations were lower in the PRP group on the operative day (P < 0.05), suggesting increased fibrinogen consumption; and more patients in the PRP group had low haptoglobin levels during CPB (8/19 vs 0/20 patients, P < 0.005), which indicated greater haemolysis in this group. We conclude that acute preoperative plateletpheresis offers no advantage in haemostasis during elective primary myocardial revascularization surgery.     

Impact of a phosphorylcholine-coated cardiac bypass circuit on blood loss and platelet function: a prospective, randomized study

Platelet dysfunction due to cardiopulmonary bypass (CPB) surgery increases the risk of bleeding. This study analyzed the effect of a phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion needs, and platelet function. We performed a prospective, randomized study at Strasbourg University Hospital, which included 40 adults undergoing coronary artery bypass graft surgery (CABG) (n = 20) or mitral valve repair (n = 20) using CPB. Patients were randomized either to PC-coated CPB or uncoated CPB (10 CABG patients and 10 mitral valve repair patients in each group). Blood loss and transfusion needs were evaluated intra- and postoperatively. Markers of platelet activation and thrombin generation were measured at anesthesia induction, at the beginning and end of CPB, on skin closure, and on days 0, 1, and 5. Comparisons were made by Student's t test or covariance analysis (significance threshold p < or = .05). Blood loss was significantly lower in the PC group during the first 6 postoperative hours (171 +/- 102 vs. 285 +/- 193 mL, p = .024), at the threshold of significance from 6-24 hours (p = .052), and similar in both groups after 24 hours. During CPB, platelet count decreased by 48% in both groups. There was no difference in markers of platelet activation, thrombin generation, or transfusion needs between the two groups. Norepinephrine use was more frequent in the control group (63% vs. 33%) but not significantly. PC-coating of the CPB surface reduced early postoperative bleeding, especially in CABG patients, but had no significant effect on platelet function because of large interindividual variations that prevented the establishment of a causal relationship.     

Tranexamic acid reduces postoperative bleeding in off-pump coronary artery bypass grafting

OBJECTIVE: Tranexamic acid (TA) reduces blood loss in coronary artery surgery with cardiopulmonary bypass. The present prospective study was designed to investigate its hemostatic effect in off-pump coronary artery bypass (OPCAB). METHOD: Seventy-six patients undergoing elective OPCAB were randomized into two groups, received TA (0.75 g loading dose before surgery and 250 mg/h during surgery, gross dose: 1.5 g, n=36) and saline solution (control, n=40), respectively. Perioperative blood samples were collected. Hematochemical parameters including platelet adhesion rate, D-dimer and fibrinopeptide-A (FPA) were analysis. Volume of blood loss, blood transfusion and other clinical data were recorded throughout the perioperative period. RESULTS: Cumulative blood loss was significantly reduced in the TA group as compared to the controls postoperatively (6 hrs (median [25th-75th]): TA: 200.0 [140.0-230.0] ml, Control: 225.0 [200.0-347.5.0] ml, p=0.009; 24 hrs: TA: 440.0 [270.0-605.0] ml, Control: 655.0 [500.0-920.0] ml, p<0.001). Number of patients received blood transfusion in each group was similar. Levels of D-dimer rose significantly after surgery, and were significantly lower in the TA group than that in controls. Platelet adhesion rate and FPA levels remained at baseline levels after the operation in two groups. Early clinical outcomes were similar between groups. CONCLUSION: The results indicated that tranexamic acid limits fibrinolysis and reduces blood loss after off-pump coronary artery bypass surgery.     

Heparin-coated versus uncoated extracorporeal circuit in patients undergoing coronary artery bypass graft surgery

OBJECTIVE: To assess the effect of heparin-coated circuits on bleeding, transfusion, and platelet count in patients undergoing primary coronary artery bypass grafting with full heparinization. DESIGN: Randomized, double-blind study. SETTING: Tertiary-care academic medical center. PARTICIPANTS: Eighty-eight patients undergoing coronary artery bypass grafting requiring cardiopulmonary bypass (CPB) without previous sternotomy. INTERVENTIONS: Subjects received either a heparin-coated or an uncoated extracorporeal circuit for CPB. Heparin, 300 micro/kg, was administered, and supplemental amounts were administered to maintain an activated coagulation time of greater than 480 seconds. Platelet counts were determined during CPB. Mediastinal chest tube drainage was collected in the intensive care unit for 24 hours. MEASUREMENTS AND MAIN RESULTS: The mean platelet counts were similar between the groups during CPB. There was no significant difference in 24-hour mediastinal chest tube drainage (mean +/- standard deviation; median) between the heparin-coated (n = 44, 1096 +/- 401, 1015 mL) and uncoated group (n = 44, 1150 +/- 548, 1040 mL; p = 0.91). The heparin-coated group received less allogeneic packed red blood cells (0.9 +/- 1.6, 0.0 v 1.5 +/- 1.8, 1.0 U; p = 0.04). CONCLUSIONS: The use of a heparin-coated or uncoated cardiopulmonary bypass circuit and full heparinization marginally reduced only red blood cell transfusion but was not associated with platelet sparing or reduced perioperative bleeding.     

Analysis of hepatic and renal dysfunction after surgery of thoracic aneurysm

To analyze causes of postoperative hepatic and renal dysfunction in patients with thoracic aneurysm, we examined 31 patients who survived surgeries and 2 patients died of MOF. The patients were separated into three groups as follows; Cardiopulmonary bypass (CPB) was used for circulatory support in group A (n = 7), CPB and low flow perfusion during open distal anastomosis in group B (n = 13) and temporary bypass or left atrial distal aorta arterial bypass was used in group C (n = 11). Operation time was significantly longer in group A (9.8 hrs) compared with group C (6.1 hrs). Amount of intraoperative blood transfusion was greater in groups A (4980 ml) and B (4860 ml) compared with group C (2320 ml). Postoperative highest total bilirubin level was significantly greater in group A (7.8 mg/dl) than group C (2.5 mg/dl). LDH was higher in groups A (1322 IU/l) and B (1336 IU/l) than group C (991 IU/l). GOT was higher in group B (200 IU/l) than group C (64 IU/l). There were no significant differences in GPT, creatinine and BUN among the three groups. Operation time and amount of intraoperative blood transfusion were positively correlated with postoperative hepatic function parameters. Two patients died of MOF showed severe hepato-renal dysfunction associated with LOS. The results indicate that hypothermic low flow perfusion during open distal anastomosis do not induce hepatic or renal dysfunction, and postoperative hyperbilirubinemia is resulted from bilirubin overload which patients can tolerate well if they are not complicated with MOF.     

Platelet-rich plasma sequestration, with therapeutic platelet yields, reduces allogeneic transfusion in complex cardiac surgery

Platelet dysfunction is the most common cause of nonsurgical bleeding after cardiopulmonary bypass (CPB). We hypothesized that reinfusion of a therapeutic quantity of platelets sequestered before CPB would decrease the need for allogeneic platelet transfusion, as well as decrease bleeding and total allogeneic transfusion, in cardiac surgery patients at moderately high risk for bleeding. Fifty-five patients undergoing either reoperative coronary artery bypass (CABG) or combined CABG and valve replacement were randomized to control or platelet-rich plasma sequestration (pheresis) groups. All patients received intraoperative epsilon-aminocaproic acid infusions. There was no significant difference between groups with respect to preoperative characteristics, duration of CPB, or target postoperative hematocrit. Mean platelet yields were 6.2 +/- 2.1 units (3.1 x 10(11) platelets). Mean pheresis time was 44 min. Allogeneic platelets (range = 6-12 units) were transfused to 28% of control patients, compared with 0% of pheresis patients (P < 0.01). Allogeneic packed red blood cells were transfused to 45% of control patients (1.2 units per patient) versus 31% of pheresis patients (0. 7 unit per patient) (P = 0.35). Total allogeneic units transfused were significantly reduced in the pheresis group (P < 0.02). Mediastinal chest tube drainage was not significantly decreased in the pheresis group. In this prospective, randomized study, therapeutic platelet yields were obtained before CPB. In contrast with recent studies with low platelet yields, these data support the conclusion that platelet-rich plasma sequestration is effective in reducing allogeneic platelet transfusions and total allogeneic units transfused in cardiac surgery patients at moderately high risk for post-CPB coagulopathy and bleeding. IMPLICATIONS: Transfusion of allogeneic blood products, including platelets, is common during complex cardiac surgical procedures. In the present prospective, randomized study, a significant reduction in allogeneic platelet transfusion and total allogeneic units transfused was observed after the reinfusion of a therapeutic quantity of autologous platelets sequestered before cardiopulmonary bypass.     

术前自体血小板分离回输在非体外循环下冠状动脉旁路移植术中的应用

目的 探讨术前自体血小板分离回输在非CPB下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)中应用的临床效果. 方法 32例OPCABG患者采用随机数字表法分为两组(每组16例):对照组(A组)行术中自体血回输,急性血小板分离组(B组)行急性等容血液稀释(acute normovoemic hemodiltion,ANH)联合自体富血小板血浆(platelet-rich plasma,PRP)回输及术中自体血回输.于麻醉诱导前(T0)、肝素化前(T1)、术后1 h(T2)、术后24 h(T3)各时间点记录有关凝血功能的各项指标.记录T2、T3时点引流液. 结果 B组急性血小板处理的全血容量为(1 100±145) ml,采集PRP(166±30) ml,血小板计数(platelet count,Plt)(1 010±210)×109/L,占全身Plt总数(26±3)％.与A组比较,B组T2时点Plt升高明显,T2、T3时点引流液降低、异体红细胞输注率降低(P＜0.05),凝血功能指标差异无统计学意(P＞0.05). 结论 术前自体血小板分离回输在OPCABG中可减少异体血输注量,减少输血费用,降低术后出血量,避免血液传播性疾病及输血反应的发生.     

Effects of urinary protease inhibitor on inflammatory response during on-pump coronary revascularisation. Effect of ulinastatin on inflammatory response

AIM: Cardiac surgery in patients undergoing cardiopulmonary bypass (CPB) provokes a vigorous inflammatory response with substantial clinical implications. Once the inflammatory response is triggered by CPB, leukocytes and platelets are activated by multiple stimuli. The administration of a urinary trypsin inhibitor (ulinastatin) during CPB is hypothesized to reduce cytokine release and platelet activation and to decrease pulmonary injury. We performed a prospective randomized study to investigate the influence of high-dose ulinastatin on cytokines and platelet activation and on respiratory function during and after CPB. METHODS: In this pilot, prospective, randomized and double-blinded study, 30 first-time three-vessel coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) were randomly divided into 2 groups: U group (n=15) received a total dose of 1000000 U ulinastatin and C group (n=15) received placebo. Blood samples were withdrawn from the central vein to measure polymorphonuclear neutrophil elastase (PMNE), tumour necrosis factor-alpha (TNF-a), interleukin-6 (IL-6) and interleukin-8 (IL-8), before induction, 30 min following clamping (T2), reperfusion 3 h (T3), reperfusion 6 h (T4) and reperfusion 12 h (T5). Whole blood samples were taken for CD62P immediately before induction (as baseline), at the end of CPB (before protamine administration), 1 h after heparin neutralization by protamine and 24 h after the operation. In addition, alveolo-arterial oxygen difference (A-aDO(2)) in pulmonary gas exchange function was calculated by obtaining arterial blood gas samples before and after CPB. RESULTS: There were no differences in preoperative parameters between the groups. After CPB, the levels of PMNE, TNF-alfa, IL-6 and IL-8 increased in both groups over baseline values (P<0.01). The levels of PMNE, TNF-alfa, IL-6 and IL-8 in U group were significantly lower than those in C group (P<0.05). No significant differences in CD62p expression between the 2 groups during CPB were found. A-aDO(2) in U group significantly decreased compared with C group (P<0.05) and the duration of mechanical ventilation was shorter than C group (P<0.05). CONCLUSION: Results suggest that ulinastatin may inhibit proinflammatory cytokine (PMNE, TNF-alfa, IL-6 and IL-8) release, reduce reperfusion lung injury and preserve pulmonary function but it fails to inhibit platelet activation and to prevent blood loss during CPB.     

Heparin-coated Cardiopulmonary Bypass Circuits in Coronary Bypass Surgery

Abstract: Cardiopulmonary bypass (CPB) is a nonphysiologic environment for an organism. The damage of blood components may also lead to organ dysfunction, sometimes recognized as postperfusion syndrome. One possible way to diminish the risk of these complications would be to reduce the thorombogenicity and to improve the biocompatibility of the artificial surfaces by using a heparin-coated CPB circuit. In this study, we compared a heparin-coated CPB circuit with a noncoated CPB circuit in terms of biocompatibility in 20 patients undergoing elective coronary bypass surgery. We employed a Dura-flo II (n = 10) as a heparin-coated CPB circuit and a Univox IC (n = 10) as control subjects. Ten patients (Group C) were operated on using the heparin-coated CPB circuit. A total of 10 patients were given heparin in a reduced dose (2.0 mg/kg), and additional heparin was given if the activated clotting time (ACT) was below 400 s. The control group also included 10 patients (Group NC), who were operated on with noncoated devices. They received 2.5 mg/kg of heparin, and additional heparin was given if the ACT was below 450 s. All patients had normal coagulation parameters and did not receive blood transfusion. We measured complement activation levels (C3a, C4a), platelet count, thrombin-antithrombin III complex levels, D-dimer levels, and ACT during CPB and respiratory index postoperatively. The concentration of C3a in group NC was significantly higher than that in group C. Platelet reduction in group NC was significantly greater than that in group C. There were no significant differences in the remaining parameters between the 2 groups. We concluded that heparin-coated CPB circuits improved biocompatibility by reducing complement activation and platelet consumption and enabled us to reduce the dose of heparin required for systemic heparinization.     

急性血小板分离回输对体外循环心脏直视手术患者的血液保护效果

目的 评价急性血小板(Plt)分离回输对体外循环(CPB)心脏直视手术患者的血液保护效果.方法 择期拟在CPB下行心脏直视手术患者30例,ASA分级Ⅱ或Ⅲ级,年龄41～63岁,体重52～72 kg.采用随机数字表法,将患者随机分为2组(n=15):对照组(C组)和急性Plt分离组(APP组).APP组在麻醉诱导后行APP,提取富Plt血浆,于CPB结束鱼精蛋白中和肝索后回输,C组不行APP.于麻醉诱导前、术后1、24和48h时记录Hb、Plt、PT、APTT及Fib.记录CPB时间、主动脉阻断时间、术后引流量和输血情况.结果 APP组急性Plt分离处理的全血容量为(1285±185) ml,采集富Plt血浆(192±38) ml,其中Plt计数(817±282)×10/L,占全身血容量Plt总数(21±3)％,Plt分离时间(35±10) min.与C组比较,APP组术后1h时Plt升高,术后24h内引流量、异体红细胞、Plt输注量和异体Ph输注率降低(P＜0.05或0.01),其余指标差异无统计学意义(P＞0.05).结论 急性Plt分离回输对CPB心脏直视手术患者具有血液保护作用.     

Preoperative autologous blood donation with cardiac surgery

BACKGROUND: Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The purpose of this study was to ascertain how much volume of predonated autologous blood need to avoid of homologous blood transfusion in cardiac procedure. METHODS: One hundred twenty-eight patients underwent scheduled cardiac procedure between January 1998 and December 1999. Group 1: 400 ml predonated, operation without cardiopulmonary bypass (CPB) [n = 33], group 2: 800 ml predonated, operation without CPB (n = 23), group 3: 800 ml predonated, operation with CPB (n = 36), group 4: 1,200 ml predonated, operation with CPB (n = 36). Surgical procedures underwent only off-pump coronary artery bypass grafting (OPCAB) in groups 1 and 2. In groups 3 and 4 included coronary artery bypass grafting (CABG), valve replacement, CABG + valve replacement and atrial septal defect repair. RESULTS: There were no significant differences in mean body weight, mean preoperative hematocrit values or mean volume of intraoperative blood loss between groups 1 and 2. There were no significant differences in mean age, mean body weight, mean preoperative and postoperative day-7 hematocrit values, mean volume of intraoperative blood loss or mean CPB time between groups 3 and 4. The mean postoperative day-7 hematocrit value was significantly lower in group 1 than in group 2. Homologous blood transfusion was avoided in 63.6% of those with predonation of group 1 versus 100% at group 2 (p < 0.05), 86.1% at group 3 versus 94.4% at group 4 (p < 0.05). In group 3, all patients who underwent redo operation or CABG + valve replacement needed homologous blood transfusion. CONCLUSIONS: Autologous blood transfusion is effective for reducing the homologous blood requirement. It also seems that predonation of 800 ml may be sufficient to avoid homologous blood transfusion in cardiac surgery, however predonation of 1,200 ml is desirable in cases of redo operation or CABG + valve replacement.     

The effect of prophylactic epsilon-aminocaproic acid on bleeding, transfusions, platelet function, and fibrinolysis during coronary artery bypass grafting.

BACKGROUND: Antifibrinolytic medications administered before skin incision decrease bleeding after cardiac surgery. Numerous case reports indicate thrombus formation with administration of epsilon-aminocaproic acid (epsilon-ACA). The purpose of this study was to examine the efficacy of epsilon-ACA administered after heparinization but before cardiopulmonary bypass in reducing bleeding and transfusion requirements after primary coronary artery bypass surgery. METHODS: Seventy-four adult patients undergoing primary coronary artery bypass surgery were randomized to receive 125 mg/kg epsilon-ACA followed by an infusion of 12.5 mg x kg(-1) x h(-1) or an equivalent volume of saline. Coagulation studies, thromboelastography, and platelet aggregation tests were performed preoperatively, after bypass, and on the first postoperative day. Mediastinal drainage was recorded during the 24 h after surgery. Homologous blood transfusion triggers were predefined and transfusion amounts were recorded. RESULTS: One patient was excluded for surgical bleeding and five patients were excluded for transfusion against predefined criteria One patient died from a dysrhythmia 2 h postoperatively. Among the remaining 67, the epsilon-ACA group had less mediastinal blood loss during the 24 h after surgery, 529+/-241 ml versus 691+/-286 ml (mean +/- SD), P < 0.05, despite longer cardiopulmonary bypass times and lower platelet counts, P < 0.05. Platelet aggregation was reduced in both groups following cardiopulmonary bypass but did not differ between groups. Homologous blood transfusion was similar between both groups. CONCLUSIONS: Prophylactic administration of epsilon-ACA after heparinization but before cardiopulmonary bypass is of minimal benefit for reducing blood loss postoperatively in patients undergoing primary coronary artery bypass grafting.     

Effets du plasma riche en plaquettes sur l'hémostase et le besoin transfusionnel en chirurgie vasculaire

• Objective :To assess the effect of intraoperative autologous platelet-rich plasma (PRP) transfusion on haemostasis, blood loss and blood requirements during vascular surgery.• Study design :Randomized clinical trial.• Patients :Twenty patients undergoing elective abdominal infrarenal aortic aneurysmectomy, using autologous transfusion techniques (predonation programme and/or preoperative normovolaemic haemodilution and/or intraoperative use of a cell-saver), were randomly allocated either into the PRP group (n = 10) or the Control group (n = 10).• Method :In patients of PRP group, 10 mL·kg⁻¹ of PRP were obtained over 40 to 50 min, prior to induction of anaesthesia, and compensated simultaneously with an equivalent amount of hydroxyethyl starch. Each PRP unit was transfused to its donor after aortic declamping. Blood samples were obtained before induction, before incision, at wound closing and at the end of PRP unit transfusion for determination of biological variables.• Results :The PRP units transfused in the patients of PRP group contained 755 ± 117 mL of plasma with a platelet count of 62 ± 31 G·L⁻¹. The intra and postoperative blood losses were similar in both groups (1622 ± 758 and 233 ± 322 mL respectively in PRP group vs 1890 ± 1331 and 291 ± 303 mL respectively in Control group). In both groups, three patients required an additional transfusion of homologous blood. The results of biological tests (haematocrit, platelet and white cell counts, prothrombine time, aPTT, thrombine time, fibrinogen, D-dimers, proteins, calcium) were also similar between groups at the various times of sampling. The reinfusion of the PRP unit did not increase the platelet count.• Conclusions :This study demonstrates that intraoperative infusion of autologous PRP does not decrease blood loss and homologous transfusion requirements in patients undergoing elective abdominal infrarenal aortic aneurysmectomy. This result can be related to the relatively moderate enrichment in platelets obtained with the centrifugation speed used in this study.     

Pericardial suction blood separation attenuates inflammatory response and hemolysis after cardiopulmonary bypass

OBJECTIVES: Retransfusion of pericardial suction blood (PSB) is critically considered under the aspect of the biocompatibility of the cardiopulmonary bypass (CPB). We investigated various indicators of inflammation and blood cell activation associated with CPB and re-transfusion of PSB during cardiac surgery. DESIGN: Thirty-five patients undergoing elective coronary artery bypass grafting were prospectively randomized into two groups. In group A (n = 15, retransfusion group) the pericardial suction blood was continuously retransfused during CPB, in group B (n = 20, no-retransfusion group) the suction blood was separated. Parameters indicating the status of the inflammation and blood cell activation were analyzed before and at the end of CPB, latest after 90 minutes on CPB. RESULTS: Patients' perioperative data did not differ between groups. The inflammatory markers C-reactive protein, PMN-Elastase and Interleukin-6 increased in both groups after CPB (p < 0.04) with significantly lower values in the no-retransfusion group (p < 0.02). Leukocytes and platelet activation markers beta-Thromboglobulin and soluble P-Selectin also experienced a significant elevation during observation time (p < 0.02) without any difference between the groups. Free hemoglobin and LDH tremendously increased during CPB with lower values in the no-retransfusion group. CONCLUSIONS: Cardiotomy suction is a major cause of hemolysis and contributes significantly to the systemic inflammatory response.     

急性等容血液稀释用于心血管外科血液保护的效果

目的 比较急性等容血液稀释(ANH)联合术中血液回收与单纯术中血液回收用于心血管外科血液保护的临床效果。方法 将术前血红蛋白Hb≥130g/L的心血管外科成年病人140例随机分成两组:A+C组,ANH联合术中血液回收(ANH量 8～12ml/kg,n=70);C组,术中单纯血液回收(n=70)。分别记录两组病人术前及术后24h血红蛋白(Hb)、血球压积(HCT)、血小板(PLT);回收血量;体外循环(CPB)总转流时间;术后24h引流量;全血用量;血浆用量;悬浮红细胞用量;冷沉淀用量;血小板用量和总住院时间。结果 两组病人一般情况无显著差异,术前各实验室指标无显著差异;A+C组术中血液回收量(581.8±28.2)ml少于C组(785.4±43.8)ml,有显著差异(P<0.001);A+C组术后24hHb(122.2±18.8)g/l高于C组(112.3±15.6)g/l,有显著差异(P<0.01),HCT(35.2±5.5)高于C组(33.2±4.5),亦有显著差异(P<0.05);A+C组全血用量(81.7±23.0)ml少于C组(217.4±35.7)ml,有显著差异(P<0.01)A+C组有15例,C组有6例未输异体血;两组间CPB时间、总住院时间及其它血制品用量无显著差异。结论ANH联合术中血液回收比较术中单纯血液回收用于心血管外科血液保护可减少异体血需要及用量,值得推广。     

Aprotinin to decrease bleeding and intraoperative blood transfusion requirements during descending thoracic and thoracoabdominal aortic aneurysmectomy using cardiopulmonary bypass

The purpose of this retrospective study was to assess the efficacy of aprotinin, an antifibrinolytic agent, in reducing bleeding and blood transfusion requirements in patients undergoing descending thoracic or thoracoabdominal aortic aneurysmectomy using cardiopulmonary bypass (CPB). Sixty-nine consecutive patients underwent thoracic or thoracoabdominal aneurysmectomy using CPB in a 2-year period. None of the 29 patients operated on in 1990 (group 1) received aprotinin, whereas all 40 patients operated on in 1991 (group 2) were placed on a high-dose regimen of aprotinin. There were no significant differences between the two groups. Administration of aprotinin was associated with a decrease in CPB time (p=0.02), surgical duration (p=0.05), and intraoperative blood loss (p=0.008) as well as a reduction in intraoperative packed red cells (p=0.01), Cell-Saver units (p=0.05), fresh-frozen plasma units (p=0.002), and platelet concentrate (p=0.01) requirements. These data suggest that aprotinin is effective in reducing bleeding and blood transfusion requirements during descending thoracic or thoracoabdominal aortic aneurysmectomy using CPB.     

Failure of autologous fresh frozen plasma to reduce blood loss and transfusion requirements in coronary artery bypass surgery

BACKGROUND: Previous studies failed to demonstrate any benefit from prophylaxis with fresh frozen plasma (FFP) after cardiopulmonary bypass (CPB). The results, however, were limited by either retrospective study design or use of FFP in subtherapeutic doses (2-3 units). The authors evaluated whether a therapeutic dose (15 ml/kg) of FFP reduces blood loss and transfusion requirements in elective coronary artery bypass surgery. The risks of multiple allogeneic blood donor exposure were circumvented by using autologous plasma. METHODS: Sixty adult patients scheduled for elective primary coronary artery bypass grafting were randomized to receive, after CPB, an intravenous infusion of 15 ml/kg of either autologous FFP (30 patients) or 6% hydroxyethyl starch 450/0.7 (HES; 30 patients). Autologous plasma was obtained by platelet-poor plasmapheresis several weeks before surgery. Perioperative blood transfusions were administered per protocol. Postoperative blood loss was defined as the chest tube drainage during the first 24 h after surgery. RESULTS: The data from 56 patients (FFP group, 27 patients; HES group, 29 patients) who completed the study according to protocol were analyzed. Median postoperative blood loss was 630 ml (range, 450-1,840 ml) and 830 ml (range, 340-1,980 ml) in the FFP and HES groups, respectively (P = 0.08). Both postoperative (0-24 h) and total perioperative erythrocyte transfusion requirements did not differ significantly between the groups (P = 0.32 and 0.14, respectively). CONCLUSION: The prophylactic administration of a therapeutic dose (15 ml/kg) of autologous FFP after CPB failed to reduce blood loss and transfusion requirements in patients undergoing uncomplicated, elective, primary coronary artery bypass surgery.