Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit

Abstract

Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous blood requirements in cardiac surgery with cardiopulmonary bypass (CPB). As the proinflammatory activity of the shed blood also contributes to morbidity during CPB, we conducted a prospective study in order to examine the quality of autologous blood before and after processing with five different devices [BRAT2, Sequestra, Compact Advanced, Cell Saver 5 (CS5), Continuous Autologous Transfusion System (CATS)]. All systems resulted in an excellent haemoconcentration, ranging from 53.7% (Compact) to 68.9% (CATS). The concentrations and elimination rates of several inflammatory markers [IL-1beta, IL-2, IL-8, TNFalpha, myeloperoxidase (MPO), elastase] were examined. Except for the Sequestra, an important increase in concentration of IL-1beta (between 30% and 220%) has been observed after processing with each device. In contrast, the attenuation rate of IL-6 and TNFalpha (95%) was optimal for all investigated blood salvages systems. Regarding IL-8, only the CATS and CS5 systems were able to attenuate this biological parameter with an excellent efficacy. The rate of attenuation in MPO and elastase, as markers of leukocyte activation, was higher than 80% for all devices. In conclusion, the different RBC washing systems tested in this study resulted in a significant attenuation of the inflammatory response. Increased levels of IL-1beta after processing remained, however, unclear. According to the type of protocol, based on inlet haematocrit, fill and wash speeds, and wash volumes, small variations in reducing the inflammatory response have been observed from one device to another.

Cell Salvage Alters the Systemic Inflammatory Response After Off-Pump Coronary Artery Bypass Grafting Surgery

“…This has also been shown in shed blood after orthopedic surgery, where the retransfusion of this blood resulted in proinflammatory alterations in the patient's systemic cytokine profile [30 -32]. Several groups have demonstrated that the use of cell savers reduces the level of inflammatory mediators in shed mediastinal blood [29,33]. Westerberg and colleagues [34] recently reported reduced plasma interleukin-6 and C3a after cardiopulmonary bypass in patients whose cardiotomy suction blood had been discarded.…”

Influence of autologous blood transfusion in liver transplantation in patients with hepatitis B on the function and hemorheology of red blood cells

“…In addition, it has been demonstrated that recovered blood cells exhibited an improved oxygen carrying capacity and stronger anti-infiltration capacity than stored blood cells, which reduce the incidence of metabolic acidosis and electrolyte imbalance caused by the infusion of a large number of stored blood cells (23). Other studies that compared intraoperative cell salvage with allogeneic blood transfusion have demonstrated an increased mean erythrocyte viability, increased 2,3-DPG (24,25) and increased ATP levels (26,27) in salvaged blood. In the present study, no significant difference in the levels of Na + K + -ATPase, Ca 2+ -ATPase, Mg 2+ -ATPase and 2,3-DPG were observed between pre-operative and recovered RBCs, suggesting that autologous blood transfusion in liver transplantation in patients with hepatitis B and decompensation had no significant influence on the functions of RBCs.…”

Intra-operative cell salvage in South Africa: Feasible, beneficial and economical

“…The RBCs are added to normal saline to obtain an HCT between 50% and 60% and are then pumped into a bag ready for transfusion. [6,7] The disposable components for suctioning and collection of blood are supplied separately from the components that perform further processing into washed packed cells (Fig. 1).…”