Quantitative and qualitative analysis of platelet-rich plasma collection using the Haemonetics Cell Saver 5 in open heart surgery

Many traditional autologous blood recovery systems (ABRSs) have undergone modifications to enable them to collect platelet-rich plasma (PRP). Because of the growing demand for autologous platelet gel (APG) in cardiac surgery, many open heart teams are faced with the choice of using their existing ABRS or purchasing a dedicated PRP device. This study was conducted to address the issues we had about our use of the Haemonetics Cell Saver 5 (CS5) to collect PRP during open heart surgery at our institution. PRP and platelet-poor plasma (PPP) were collected on 20 "first-time" elective open heart surgical patients. Baseline, PRP, and PPP platelet counts, as well as modified thrombelastograms (TEGs), were performed on all study patients. The mean baseline, PRP, and PPP platelet counts were 232,450, 1,348,850, and 18,100/mm3, respectively. We found a strong positive correlation (r = +0.7142) between the maximum amplitude (MA) of our modified PRP TEG and the platelet count of the PRP. Using the CS5, we achieved a mean platelet multiple of greater than six times baseline, which compares favorably with the multiple produced using dedicated PRP devices. These data support the conclusion that we achieved a high platelet multiple with the CS5, and our use of a modified TEG showed that platelet function of the collected PRP was preserved.     

Danaparoid (Orgaran) zur Antikoagulation bei der maschinellen Autotransfusion mit Cell Saver 5 (Haemonetics)

We investigated Danaparoid Sodium (Orgaran) as anticoagulant using three different concentrations (9, 4,5 or 3 U/ml anticoagulant solution) for the use in the autotransfusion device Cell Saver 5 (Haemonetics). Fresh units of whole blood packs were mixed in the reservoir in a proportion of 5:1 with the anticoagulant solution. Having started the Cell Saver 5 in the automatic mode, the amount of Danaparoid in the retransfusion blood was determined (chromogenic Antifactor-Xa test). The lowest concentration of the anticoagulant was applied in 4 patients with Heparin-induced Thrombocytopenia Type II undergoing total hip arthroplasty. There was a correlation between the concentration in the reservoir and in the retransfusion blood. None of the patients showed a disturbance of his coagulation system. One of them had slight clotting in the reservoir. We recommend the use of the lower concentrations tested: 4,5 U/ml or, particularly for patients with renal insufficiency or low body weight or expected high retransfusion volumes, 3 U/ml as anticoagulant concentrations. If the autotransfusion device is used according to the manufacturer's instructions there may be virtually no risk of clotting in the Cell Saver or of inhibition of the coagulation system in the patient.     

The Cell Saver during Cardiac Surgery: Does It Save?

Conservation and autotransfusion of autologous blood have been proposed as a means to decrease the homologous blood requirements of cardiac surgery. Use of the Haemonetics Cell Saver System to salvage blood shed in the sterile surgical field resulted in a net saving of 105 +/- 88.7 ml of packed red cells in 20 patients undergoing cardiopulmonary bypass. The system is not a cost-effective way to save blood or decrease homologous blood requirements during routine cardiac operations.     

Thermal effects of different dialysis techniques and blood pump speeds: an in vitro study

Thermal effects have a pivotal impact on hemodynamic stability during dialysis procedures. In contrast to conventional dialysis techniques, there are no data in the literature regarding the thermal energy balance during on-line techniques. Secondly, little data exist on the effect of extracorporeal blood pump speed (EBPS) on thermal energy balance. In this study we assessed, first, relative differences in energy transfer rate (ETR) over the extracorporeal circuit during on-line hemo(dia)filtration (H(D)F) procedures and hemodialysis (HD) at different dialysate temperatures during an in vitro procedure using a blood temperature monitor (BTM). Secondly, we assessed the thermal effects of different blood pump speed (BPS) rates during the various treatment modalities. ETR was different among all treatment modalities (p < 0.05) studied, except for HD at 36.5 degrees C vs. pre-dilution hemofiltration (HF) and post-dilution HDF vs. HD at 37.5 degrees C. ETR had the most negative result, indicating the largest energy loss, during HD at 35.5 degrees C (-58.5.2 +/- 2.6 W), whereas it was almost comparable between pre-dilution HF (-30.7 +/- 4.1 W) and HD at 36.5 degrees C (-35.1.2 +/- 2.4 W). Post-dilution HDF (-17.7 +/- 1.2 W) resulted in an ETR comparable to that of HD at 37.5 degrees C (-15.0 +/- 3.9 W). ETR during post-dilution HF was -43.8 +/- 1.3 W. The thermal effect of the BPS was more pronounced during the procedures with the more negative ETR. In conclusion, on-line techniques and BPS have widely varying effects on ETR during dialysis, which should be considered when the hemodynamic effects among different treatment modalities are compared.     

不同加载速度对大鼠骨生物力学特性的影响

本实验观察了在三点弯曲力学实验中,在不同运动速度（５ｍｍ／ｍｉｎ,２０ｍｍ／ｍｉｎ）的加载条件下,即在不同的加载速度时,大鼠肱骨最大载荷、弹性载荷、最大挠度、弹性挠度、最大应力、弹性应力、最大应变、弹性应变８项骨生物力学指标的变化特点。结果表明：与５ｍｍ／ｍｉｎ加载速度相比较,在２０ｍｍ／ｍｉｎ加载速度下,骨最大载荷、弹性载荷、最大挠度、弹性挠度显著增加（Ｐ＜０．０５）;骨最大应力、弹性应力、最大应变、弹性应变无明显变化。提示：三点弯曲力学实验中,在一定范围内提高加载速度,主要影响骨结构力学特性,而对骨材料力学特性无明显影响     

Haptoglobin determination in the serum of patients following intraoperative autotransfusion using the Haemonetics Cell Saver III. Studies on the loading of patients with free hemoglobin in retransfused erythrocyte concentrate

In addition to hemodilution, mechanical intraoperative autotransfusion (IAT) is the most important method of preventing or minimizing the transfusion of homologous blood in operations with major blood loss. Most of the problems associated with IAT could be solved by the use of cell separators, but the separated red blood cells still contain an average of 200 mg/dl free hemoglobin. By the determination of haptoglobin levels before and after IAT, we studied the effects of free hemoglobin on the patient. Seventy-seven patients with hip-joint replacement were studied. In one group, n = 47, both intraoperative blood loss and drainage blood (for 6 h post-operatively) were collected and transfused back to the patient after cell separation with the Haemonetics Cell-Saver III as a red-cell concentrate. A second group, n = 34, received only homologous blood. Serum haptoglobin was determined after anesthesia induction and after the last transfusion on the day of operation. There were no significant differences in preoperative haptoglobin levels between both groups. In the IAT group, haptoglobin was significantly lower then in the control group after transfusion (t-test, P = 0.05). In both groups 14% of the patients' haptoglobin levels were pathologic preoperatively. Post-transfusion 60% of the IAT group showed minimum levels while in another 14% no haptoglobin could be measured. In these 14%, free hemoglobin was circulating in the patients' blood because the transport capacity was exhausted. In the control group only 26.5% of the haptoglobin levels were below normal and in no case was transport capacity exhausted (Table 3). The correlation between volume of retransfused autologous blood and decrease in haptoglobin level was small (r = 0.15). In a few cases with low volumes of retransfused blood the haptoglobin decrease may have been greater, so that free hemoglobin may have been present.     

全自动自体血液回收系统在大血管外科手术中的应用

目的　介绍全自动血液回收系统在复杂大血管手术中应用的经验。　方法　６ 例动脉瘤和１ 例肝血管瘤手术患者,在全身麻醉下行人造血管置换或动脉瘤部分切除术,在手术开始或体外循环结束时,启用全自动血液回收系统,回收术野的出血或渗血,进行浓缩、洗涤后,再回输入体内,并按回收浓缩洗涤回输程序重复进行。　结果　７ 例患者平均回收血量３ １０７ｍｌ（１ ３００８ ５００ ｍｌ） ,洗涤红细胞１ １２５ｍｌ（６７５２ ９２５ｍｌ） 。平均输注佳乐施或海脉素２ ０００ｍｌ,２ 例术中输入全血和血浆,术中血流动力学稳定。术后如期出院。　结论　复杂的大血管手术应用全自动血液回收系统具有广泛的适应证,是节约用血、减少输用库血的可靠方法。     

Variations in battery life of a heart-lung machine using different pump speeds, pressure loads, boot material, centrifugal pump head, multiple pump usage, and battery age

Electrical failure during cardiopulmonary bypass (CPB) has previously been reported to occur in 1 of every 1500 cases. Most heart-lung machine pump consoles are equipped with built-in battery back-up units. Battery run times of these devices are variable and have not been reported. Different conditions of use can extend battery life in the event of electrical failure. This study was designed to examine the run time of a fully charged battery under various conditions of pump speed, pressure loads, pump boot material, multiple pump usage, and battery life. Battery life using a centrifugal pump also was examined. The results of this study show that battery life is affected by pump speed, circuit pressure, boot stiffness, and the number of pumps in service. Centrifugal pumps also show a reduced drain on battery when compared with roller pumps. These elements affect the longevity and performance of the battery. This information could be of value to the individual during power failure as these are variables that can affect the battery life during such a challenging scenario.     

The effect of washing and drying practices on skin barrier function.

PURPOSE: The aim of this study was to explore the potential contribution to skin damage caused by standard washing and drying techniques used in nursing. DESIGN: An experimental cohort design was used, with healthy volunteers (n = 15) receiving 6 different washing and drying techniques to the volar aspect of the forearm. Subjects underwent 3 washing and drying techniques on each arm; each technique was repeated twice, separated by a 2-hour rest period. METHODS: Skin integrity was assessed by measuring transepidermal water loss (TEWL), skin hydration, skin pH, and erythema. Comparisons were made between washing with soap or water alone, and drying using a towel (rubbing and patting) or evaporation. The significance of any difference was assessed by nonparametric analysis. The study was approved by the local research ethics committee, and all volunteers gave informed consent. RESULTS: TEWL was seen to increase following each type of wash, and increased further following repeated washing. Drying of the skin by patting with a towel increased TEWL to give readings identical to those obtained from wet skin. There was an increase in skin pH with all washing and drying techniques, particularly when soap was used. Erythema also increased with repeated washing, particularly when soap was used. No significant changes were observed in skin hydration as measured by a corneometer, although there was a tendency for the values to decrease with washing. CONCLUSIONS: These data suggest that washing with soap and water and towel drying has a significant disrupting effect on the skin's barrier function. There is tentative evidence to suggest that a cumulative effect may exist with damage increasing as washing frequency increases. Drying the skin by patting with a towel offers no advantage to conventional gentle rubbing as it leaves the skin significantly wetter and at greater risk of frictional damage.     

The effects of different harvesting techniques,adrenaline, and centrifuge on the survival of fat grafts

The effects of different harvesting techniques, local adrenaline infiltration, and centrifuge on fat graft survival and stability were studied. Twenty-four adult female Guinea pigs weighing 580–700 g were divided into three groups (groups A, B, and C), each with eight subjects. Fat grafts were harvested from the back of the animals. The left side was used for simple excision and the right for liposuction in harvesting the grafts; they were named subgroups 1 and 2, respectively. Group A was the control group. In group B, the grafts were incubated in 1/100,000 adrenaline solution for 15 min. In group C, they were centrifuged at 2,000 rpm for 3 min before placing them in the abdominal area of the same subjects. Again, the left side was used for placement of excised material and the right one for lipoaspirate. At the third postoperative month, all subjects were reoperated on to remove the grafts, and the extracted material was studied macroscopically and histopathologically. In the groups where liposuction was utilized for graft harvest, the graft resorption ratios and volume loss have been significantly increased. Adrenaline infiltration had no effect, either macroscopically or histopathologically. Although the centrifuge did not seem to have a significant effect macroscopically, the histopathologic study revealed its significant negative effects on grafts harvested by simple excision.     

Elastase levels in salvaged blood and the effect of cell washing

Blood was salvaged from the operating field of 16 orthopaedic and vascular operations and processed by the Shiley Dideco cell saver for retransfusion. Plasma elastase levels in the salvaged blood were used as a marker of white cell lysosomal granule release. The plasma level of this enzyme was measured by the technique described by Dreher et al. using the immuno-activation (IMAC) system (Merck-Darmstadt, Federal Republic of Germany). The levels of the enzyme rose dramatically in the salvaged blood and were reduced to preoperative levels after washing in the cell saver. Washing of the salvaged blood before retransfusion is effective in reducing the plasma levels of white cell lysosomal contents which have the potential for producing harmful systemic effects.     

The effect of different hormone replacement therapy regimens on the mechanical properties of rat vertebrae

The purpose of this study was to examine the effects of estrogen replacement, in concert with three different progestin regimens, on the mechanical properties of rat lumbar vertebrae. Ninety-two Sprague-Dawley rats (11 months old) were divided into six groups for treatment. The first group was an intact control, the second group (OVX) was ovariectomized only, and the third group (estrogen-only) was ovariectomized and received continuous estrogen through a 17-estradiol implant. The remaining groups were ovariectomized and received estrogen and progestin (norethindrone, NET) therapy; 3 g of NET was injected daily (estrogen plus continuous NET), or 6 g of NET was injected for 14 consecutive days of a 28-day cycle (estrogen plus cyclic NET), or for 3 consecutive days of a 6-day cycle estrogen plus interrupted NET). The animals were sacrificed after 6 months, and the vertebrae were dissected out. The vertebral processes of the fourth lumbar vertebrae were removed, and the density of the vertebral bodies was determined. They were then subjected to compression testing.We found that all three estrogen/progestin regimens maintain bone density and all mechanical properties at a level indistinguishable from the control. However, the cyclic and continuous NET treatment results were, with the exception of density, also indistinguishable from those of the ovariectomized group. The estrogen plus interrupted NET group on the other hand, has a significantly greater compressive modulus and density than the ovariectomized group. In conclusion, with respect to the ovariectomized group, the estrogen plus interrupted NET treatment resulted in a superior density and compressive modulus. The remaining mechanical properties were equivalent to those resulting from the continuous or cyclic progestin regimens.     

主动脉外气囊隔膜泵心脏辅助装置的动物实验

目的 探讨主动脉外气囊隔膜泵心脏辅助治疗对心肌梗死后犬的影响,观察主动脉外反向搏动辅助的有效性及可行性.方法 结扎冠状动脉左前降支制作急性心肌梗死心衰动物模型12只,随机分为辅助组和对照组各6只.观察心肌梗死后两组动物1～6 h血流动力学指标、梗死面积和血液形态学等指标变化.结果 辅助组6只犬全部存活,对照组死亡3只(50%).辅助组经反搏辅助后平均压,心输出量,心指数优于对照组(P＜0.05),但对血细胞有破坏.结论 主动脉外气囊隔膜泵反向搏动心脏辅助能显著地改善心肌梗死动物血流动力学,减少死亡,破坏血细胞是其不足之处.

Abstract：

Objective The aim of this study was to determine the effect of a new method of cardiac assistant therapy with an extra-aortic balloon pump on the experimental dogs in which myocardial ischemia or infarction were induced, and to ob serve its effectiveness and feasibility. Methods Twelve animal models of myocardia 1 infarction were established with the method of left anterior descending coronary artery ligation. They were divided randomly into two groups, six in the experimental group and six in the untreated group. The end points observed were the differences between the two groups in the blood pressure, cardiac function, myocardial enzymes, infarction size and routine blood variables before procedure, 1,2, 3, 4, 5 and 6 hours after myocardial infarction. Results All six dogs in the experimental group were survived, with a mortality rate of 0.The number of death in the control group was three, with a mortality rate of 50%. Measurements such as mean blood pressure,cardiac output, cardiac index in the experimental group were better than those in the control group ( P ＜ 0.05 ). Mean heart rate before myocardial infarction in the experimental group was 156 beats per minute, as compared with 148 beats per minute in the control group, and was 128 vs. 67 beats per minute respectively six hours after myocardial infarction. The cardiac output was 3.48 vs. 4.98 liters per minute before myocardial infarction and was 6.10 vs. 0.85 liters per minute six hours after myocardial infarction. The average pressure was 94 mm Hg vs. 99 mm Hg before myocardial infarction and was 70 mm Hg vs. 33 mm Hg six hours after myocardial infarction. Conclusion The extra-aortic balloon pump significantly improved the hemodynamic variables of the experimental animals after myocardial infarction and reduced mortality. Injury to the blood cells may be the potential disadvantage.