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Published on: July 21, 2016
Efficacy of leukocyte depletion of residual pump blood
E M Heerdt1, E J Fransen, J G Maessen
1Department of Extra-Corporeal Circulation, University Hospital Maastricht, The Netherlands. e.heerdt@scpc.azm.nl
Insights
Leukocyte depletion from heart-lung machine blood after cardiopulmonary bypass effectively reduces circulating leukocytes for several hours. This technique shows potential for long-term benefits in cardiac surgery patients, warranting further investigation.
Area of Science:
- Cardiovascular Surgery
- Hematology
Background:
- Cardiopulmonary bypass (CPB) involves residual blood in the heart-lung machine.
- Leukocytes in this residual blood can impact systemic circulation post-surgery.
Purpose of the Study:
- To investigate the efficacy of leukocyte depletion from residual CPB blood.
- To assess the impact on systemic leukocyte counts in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- Randomized controlled trial with 26 CABG patients.
- Leukocyte depletion group: residual blood filtered through leukocyte-removal filters.
- Control group: residual blood reinfused without filtration.
Main Results:
- Leukocyte depletion removed >96% of leukocytes from reinfused blood.
- Significantly reduced circulating leukocytes compared to controls (p < 0.05).
- Sustained reduction observed at 4 and 8 hours post-reinfusion.
Conclusions:
- Leukocyte removal from residual CPB blood is highly effective.
- This intervention leads to a prolonged reduction in circulating leukocytes.
- Clinical significance requires further study in ongoing research.
Abstract:
In this study, we examined whether leukocyte depletion from the residual heart-lung machine blood at the end of cardiopulmonary bypass (CPB) has an effect on the leukocyte counts in the systemic circulation. Twenty-six patients undergoing coronary artery bypass grafting (CABG) were randomly allocated to a leukocyte-depletion group or a control group. In the leukocyte-depletion group (n = 13), all residual blood (400 mL to 1.4 L) was filtered by leukocyte-removal filters (Pall RS01) and reinfused to the patient after CPB, whereas, in the control group, an identical amount of residual blood after bypass was reinfused without filtration (n = 13). Leukocyte-depleted allogeneic blood was transfused if needed. Preoperative risk profiles, pump support and duration of aortic crossclamping time were identical in both patient groups (ns). Leukocyte depletion removed more than 96% of leukocytes from the residual retransfused blood (p < 0.01) and significantly reduced circulating leukocytes (p < 0.05) compared with the control group. Remarkably, lower numbers of circulating leukocytes were found, not at 1 hour after reinfusion, but at 4 and 8 hours after reinfusion (p < 0.05). There were no statistical differences between the two groups with respect to postoperative blood loss, the number of transfused packed red cells and mechanical ventilation time. These results show that leukocytes can be removed from the residual blood of the heart-lung machine after CPB very effectively. Furthermore, this leukocyte depletion results in a long-term effect, the clinical significance of which has to be elucidated in ongoing studies.
