Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique - a randomized pilot study

Blekinge Institute of Technology, Department of Health Science, Karlskrona, Sweden. Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden. Department of Cardio-Thoracic Surgery, Blekinge Hospital, Karlskrona, Sweden. Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden. Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden. Department of Cardio-Thoracic and Vascular Surgery and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden. Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.

Perfusion. 2017;:267659117733891.
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Abstract
INTRODUCTION Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques. METHODS Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles). RESULTS Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups. CONCLUSIONS The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.
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Language : English
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