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Autotransfusion in coronary artery bypass grafting: disparity in laboratory tests and clinical performance
H I Flom-Halvorsen1, E Ovrum, G Tangen
1Department of Cardiac Surgery, Oslo Heart Center, University of Oslo, Rikshospitalet, Oslo, Norway.
Insights
Autotransfusion in cardiac surgery moderately activates hemostatic and inflammatory markers in stored blood. Despite significant activation in mediastinal blood, autotransfusion showed no harmful clinical effects and minimized the need for allogeneic transfusions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Hemostasis and Thrombosis
Background:
- Autotransfusion is common in cardiac surgery.
- Its detailed effects on coagulation, fibrinolysis, and inflammation are not fully understood.
Purpose of the Study:
- To investigate the hemostatic and inflammatory effects of autotransfusion during and after cardiac surgery.
- To evaluate the clinical outcomes in a large patient cohort.
Main Methods:
- Studied hemostatic and inflammatory markers in 40 coronary artery bypass patients with a consistent autotransfusion protocol.
- Evaluated clinical results in 4916 consecutive coronary patients using the same protocol.
Main Results:
- Autologous blood in the extracorporeal circuit showed moderate activation of coagulation and fibrinolysis.
- Mediastinal shed blood exhibited complete coagulation and highly elevated inflammatory markers.
- Autotransfusion led to temporary increases in plasma markers but no significant clinical adverse effects.
Conclusions:
- Autotransfusion activates hemostatic and immunologic systems, particularly in mediastinal blood.
- No correlating clinical side-effects were observed.
- Autotransfusion minimized the need for allogeneic blood products.
Objective:
Autotransfusion during and after cardiac surgery is widely performed, but its effects on coagulation, fibrinolysis, and inflammatory response have not been known in detail.
Methods:
Hemostatic and inflammatory markers were extensively studied in 40 coronary artery bypass patients undergoing a consistent intraoperative and postoperative autotransfusion protocol. An identical autotransfusion protocol was applied to 4916 consecutive coronary patients and the overall clinical results were evaluated in this large patient population.
Results:
The autologous blood pooled before bypass remained nearly inactivated after storage. A slight elevation of thrombin-antithrombin complex and prothrombin fragment 1.2, as well as plasmin/alpha(2)-antiplasmin complex was found in the content of the extracorporeal circuit after surgery, indicating thrombin formation and fibrinolytic activity. Also some increase of beta-thromboglobulin was present. In the mediastinal shed blood, complete coagulation, as evidenced by the absence of fibrinogen, had taken place and all parameters described above were extremely elevated. However, no thrombin activity was detected. As for the inflammatory response, moderately increased levels of complement activation products, terminal complement complex, and interleukin-6 traced in the extracorporeal circuit reached very high levels in mediastinal shed blood. Autotransfusion of the residual extracorporeal circuit blood and the mediastinal drainage was followed by elevation of most of these markers in circulating plasma. On the other hand, no correlating harmful effects were recorded in the study patients or in the consecutive 4916 patients. Coagulation disturbances were rare and allogeneic transfusions were required in fewer than 4% of all patients.
Conclusions:
The hemostatic and immunologic systems were moderately activated in the autologous blood remaining in the extracorporeal circuit, whereas the mediastinal shed blood was highly activated in all aspects. However, autotransfusion had no correlating clinical side-effects and the subsequent exposure to allogeneic blood products was minimal.
