Effects of intraoperative plasmapheresis on blood loss in cardiac surgery

Jones, James W.; McCoy, Timothy A.; Rawitscher, Robert E.; Lindsley, David A.

doi:10.1016/0003-4975(90)90305-p

Cited by 79 publications

(24 citation statements)

References 21 publications

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“…The efficiency of both plasmapheresis and thrombopheresis has been evaluated in many studies. Some have reported lower requirements for allogeneic blood transfusion [19,20,21] as well as lower post-operative blood losses [22]. A positive effect of pre-operative plasmapheresis has been demonstrated by low tendency to pathological fibrinolysis [23].…”

Section: Wwwintechopencommentioning

confidence: 99%

Hemotherapy in Cardiac Surgery

Wágner¹

2012

Perioperative Considerations in Cardiac Surgery

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Section: Wwwintechopencommentioning

confidence: 99%

Hemotherapy in Cardiac Surgery

Wágner¹

2012

Perioperative Considerations in Cardiac Surgery

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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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“…A recent meta-analysis 69 examined 17 prospective, randomized studies on PRP effects including patients with primary 53,54,57,68,72,75,77 or repeat 58,61,63 cardiac surgery, CABG and valve corrections 62,76,78 . The overall analysis showed that IP reduces the volume of lost blood and the mean units transfused per patient as well as the likelihood of exposure to allogeneic red cells (odds ratio 0.44).…”

Section: Blood Saving Benefitmentioning

confidence: 99%

Intraoperative Autotransfusion of RBC and PRP

Gombotz

Kulier

1999

Transfus Alt Transfus Med

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IntraoperativeAutotransfusion of RBC and PRP TATM 1999;3:5-13 • Intraoperative autotransfusion In addition, IP may be used when other autologous whole blood harvesting techniques are not an option. DEPARTMENT OF ANESTHESIOLOGY AND INTENSIVE CARE UNIVERSITY OF GRAZ GRAZ, AUSTRIATransfusion Alternatives in Transfusion Medicine VOLUME 1 NUMBER 3 DECEMBER 1999 Background summaryIntraoperative autotransfusion (IAT) is defined as the reinfusion of patient blood salvaged during and after surgery. IAT plays an important role in the context of perioperative blood saving strategies, having gained standard-of-care status in many surgical procedures 1,6 .The principle of IAT is to collect intraor postoperatively shed blood continuously from the operative field. The salvaged blood is aspirated from the wound site and collected in a dedicated reservoir. Under standard conditions, red cells are subsequently separated, washed, concentrated and stored for later retransfusion to the patient. Only erythrocytes are saved and retransfused; simultaneous volume and plasma replacement has to be provided, especially after processing of large quantities of shed blood 4 .In contrast to stored RBCs, freshly salvaged autologous red cells show uncompromized functional capacity, oxygen delivery to tissues and survival, indicating that IAT has no significant detrimental effects on erythrocytes 7,8 . IAT is most effective when combined with other autologous methods, particularly with preoperative autologous blood donation, acute normovolemic hemodilution or adjuvant drug therapies 4, 9, 10 . Methods Cell separation (washed blood)This technique is based on centrifugation, separating red blood cells (RBCs) from the lighter components and fluids, including plasma, saline and the buffy coat (Cell Saver, Haemolite ® , Haemonetics TM , Braintree, MA; Figure 1). Before starting the procedure, the operator must fill the system with 100-200 mL heparinized saline ("priming"), in order to prevent cells from binding to membrane surfaces initiating microaggregation, and to diminish frictional forces and damage to the cellu- Figure 1lar components 4,8 . Blood released at the wound site is aspirated via a double-lumen suction catheter (80-100 mm Hg), immediately anticoagulated (30,000 IU heparin in 1000 mL saline) at the suction tip, and stored in a plastic cardiotomy reservoir, equipped with a 120 µm microaggregate filter. When a minimum of 1000 mL shed blood is collected, it is pumped into a rotating separation chamber (Latham bowl, 225 mL adaptable capacity), washed with 1000-1500 mL saline and concentrated. Whenever the extent or kind of surgical debris requires more extensive washing, processing cycles can be selected manually, and in emergency cases, washing can be skipped entirely. For pediatric patients, smaller centrifuges are available. As soon as the preset hematocrit is reached, the spinning separator chamber stops, and packed RBCs, suspended in saline solution, are pumped into an infusion bag, while the waste products are removed 4, 11 . Afte...

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Effects of intraoperative plasmapheresis on blood loss in cardiac surgery

Cited by 79 publications

References 21 publications

Hemotherapy in Cardiac Surgery

Hemotherapy in Cardiac Surgery

Blood Conservation During Pediatric Cardiac Surgery

Intraoperative Autotransfusion of RBC and PRP

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