Autologous Platelet-Rich Plasma in Cardiac Surgery: Effect on Intraoperative and Postoperative Transfusion Requirements

Giordano, Gerald F.; Rivers, Shirley L.; Chung, George K.T.; Mammana, Robert B.; Marco, Joseph D.; Raczkowski, Allen R.; Sabbagh, Adib H.; Sanderson, Richard G.; Strug, Burt S.

doi:10.1016/s0003-4975(10)64655-3

Cited by 107 publications

(24 citation statements)

References 2 publications

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“…[44][45][46][47][48][49][50] Yamamoto et al compared PRP with autologous fresh whole blood in adults and found PRP to reduce blood loss after heparin neutralization. 51 The year 2000 saw a resurgence of PRP use in adult and pediatric cardiac surgery.…”

Section: Platelet-rich Plasmamentioning

confidence: 99%

Blood Conservation During Pediatric Cardiac Surgery

Gómez

Olshove

Weinstein

et al. 2002

Transfus Alt Transfus Med

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1 Blood conservation techniques in adult and pediatric cardiac surgery have evolved over the past 50 years. Congenital cardiac surgical repair with CPB has induced up to a 300% hemodilutional effect.2,3 In the 1960s, disposable CPB equipment was developed and non-heme primes were utilized to reduce transfusion exposure. 4,5Today, the first question many parents ask is not "Is my child fine?" but "Did my child receive any blood?" The public's perception of banked blood being tainted has prompted surgeons to limit or eliminate blood transfusions. Autologous donation has helped reduce the need for homologous transfusion. In pediatrics, however, this technique is limited by kilogram weight.6 Indeed, weight loss and preoperative anemia have been found to be highly significant predictors for the need of red blood cell transfusion and postoperative morbidity. 7-12Cardiopulmonary bypass causes a total body inflammatory response and dilution of coagulation factors, a phenomenon which exacerbates postoperative bleeding. Preoperative treatment of anemia and coagulation imbalances has reduced blood transfusions. 13 The use of antifibrinolytics has changed transfusion patterns due to reduced postoperative bleeding. Cell salvaging systems have become commonplace in the operating room and intensive care unit. Modified ultrafiltration, commonly used in pediatrics, has been effective in increasing hematocrit (Hct) levels, concentrating patient plasma volume, and reducing the body's inflammatory response to cardiopulmonary bypass.

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Section: Platelet-rich Plasmamentioning

confidence: 99%

Blood Conservation During Pediatric Cardiac Surgery

Gómez

Olshove

Weinstein

et al. 2002

Transfus Alt Transfus Med

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“…Several studies have shown a reduction in the need for blood transfusion, fresh frozen plasma, and platelet concentrates with the use of autologous, platelet-rich plasma in cardiac surgery. [28][29][30] Our transfusions of autologous, platelet-rich plasma contained a mean platelet count of 4.5× 10 9 /L for 300 to 400 mL. According to our blood bank, this amount is equal to 6 to 8 U from random donors.…”

Section: Commentmentioning

confidence: 99%

Liver Transplantation Without the Use of Blood Products

et al. 1994

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Objectives-To examine the techniques and the outcome of liver transplantation with maximal conservation of blood products and to analyze the potential benefits or drawbacks of blood conservation and salvage techniques. Design-Case series survey.Setting-Tertiary care, major university teaching hospital.Patients and Methods-Four patients with religious objections to blood transfusions who were selected on the basis of restrictive criteria that would lower their risk for fatal hemorrhage, including coagulopathy, a thrombosed splanchnic venous system requiring extensive reconstruction, active bleeding, and associated medical complications. All patients were pretreated with erythropoietin to increase production of red blood cells. All operations were performed at the same institution, with a 36-month follow-up.Interventions-Orthotopic liver transplantation that used blood salvage, plateletpheresis, and autotransfusion and the withholding of the use of human blood products with the exception of albumin.Main Outcome Measures-Survival and postoperative complications, with the effectiveness of erythropoietin and plateletpheresis as secondary measures.Results-All patients are alive at 36 months after orthotopic liver transplantation. One patient, a minor (13 years of age), was transfused per a state court ruling. Erythropoietin increased the production of red blood cells as shown by a mean increase in hematocrit levels of 0.08. Plateletpheresis allowed autologous, platelet-rich plasma to be available for use after allograft reperfusion. Three major complications were resolved or corrected without sequelae. Only one patient developed postoperative hemorrhage, which was corrected surgically. The mean charge for bloodless surgery was $174 000 for the three patients with United Network for Organ Sharing (UNOS) status 3 priority for transplantation. This result was statistically significant when these patients were compared with all the patients with UNOS status 3 priority during the same period who met the same restrictive guidelines (P<.05). Only 19 of 1009 orthotopic liver transplantations performed at our institution were similiar according to the UNOS status and the fulfillment of the guidelines. The mean charge for these comparison patients was $327 000, 3.8% of which was related to transfusions.

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“…The platelet-rich plasma is stored at room temperature during surgery and is returned after the conclusion of the procedure [62]. Although perioper ative hemostasis in patients for whom platelets have been prepared and reinfused in this manner is stated to be im proved, controlled clinical trials have not been reported.…”

Section: Forms Of Autologous Transfusion Practicementioning

confidence: 99%