Influence of residual blood autotransfused from cardiopulmonary bypass circuit on clinical outcome after cardiac surgery

Abstract

Autotransfusion of the residual blood from the cardiopulmonary bypass (CPB) circuit is considered to be one of the methods enabling reduction in the need for transfusion, the possible adverse effects of which are well known and documented. The aim of the study was to evaluate the effectiveness of the autologous autotransfusion of centrifuged red blood cells from the residual blood of the CPB circuit in patients following heart surgery. Three groups of patients who underwent heart surgery were examined. The first group (Group 1) consisted of 37 patients who received all of the residual blood in the bypass circuit after CPB (collected into sterile plastic bags) during the early postoperative period. The second group (Group 2) consisted of 45 patients who did not receive the residual blood following CPB. The third group (Group 3) consisted of 42 patients who underwent reinfusion of centrifuged red blood cells from the residual blood remaining in the CPB circuit during the early postoperative period. Hematocrit (Hct) values 12 hours after the operation were found to be higher in Group 3 compared with those of the first and the second groups (by 13.2% and 11.1%, respectively). Blood loss during the first 12 hours after the operation and during the time spent in the intensive care unit did not differ between the groups. The number of transfusions was significantly lower in Group 3 (28.57%) in comparison with that of Groups 1 and 2 (37.83% and 38.10%, respectively). The rate of infective complications in Group 3 was lower in comparison with both Group 1 and Group 2 (9.2% and 18.1%, respectively). The duration of in-hospital stay in Group 3 was 25.8% shorter than Group 1. We conclude that autotransfusion of centrifuged red blood cells processed from the residual blood of the CPB circuit after CPB was effective in increasing Hct values 12 hours postoperatively, reducing the need for donor blood product transfusions, the rate of infective complications and lenght of stay in hospital.

Is Allogeneic Blood Transfusion a Risk Factor for Sternal Dehiscence Following Cardiac Surgery? A Prospective Observational Study

“…5,6,19) Allogeneic blood transfusion represents a possible risk for its recipients. The immunomodulation affects in-hospital morbidity and mortality, 7,8,17,19) increases the risk of infectious complications, [9][10][11][12]19) prolongs hospitalization, 11,13) and increases costs. The restrictive approach to allogeneic blood transfusion should always be adhered to, 19) and the guidelines for alternatives to blood transfusion should be followed.…”

Hemostatic function and inflammatory activation after weaning from cardio pulmonary bypass

“…The blood in the circuit after weaning from CPB contains bioactive components such as micro aggregates, free hemoglobin, products of coagulation and vasoactive substances 10 that could promote coagulation, inflammation and organ damage 12,13 .…”

“…The infusion bag is retransfused either as it is or washed in a cellsaver 23 . It has been shown that when the blood is washed in a cellsaver the quality is improved 10,24,25 because heparin, inflammatory mediators and by-products from coagulation and fibrinolysis are removed. In the cellsaver, plasma proteins, clotting factors and viable platelets are washed away 25,26 and only the erythrocytes will be retransfused to the patient.…”

“…Retransfusion of the residual pump blood is considered to be one method to reduce the need for allogenic blood transfusion 10,23 and to raise the hemoglobin levels 10,22 . Today there are three methods for transfusion available.…”

“…A way to minimize blood bank requirements is to re-transfuse the remaining blood in the CPB circuit, the residual pump blood, after weaning from CPB. The residual pump blood in the CPB circuit contains bioactive agents that are products of coagulation and fibrinolysis as well as free hemoglobin and vasoactive substances 10,11 , products that can be associated with adverse outcomes 12,13 .…”