Heparin concentration in cell salvage during heparinization: a pilot study

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Transfusion Medicine

Background:

• Cell salvage is a common practice to minimize allogeneic blood transfusions during cardiovascular surgery.
• Concerns exist regarding potential heparin contamination in salvaged blood, which could affect patient anticoagulation.
• Heparin is crucial for maintaining anticoagulation during cardiopulmonary bypass, with target activated clotting times exceeding 400 seconds.

Purpose of the Study:

• To investigate the presence and quantity of heparin in salvaged blood during cardiovascular surgery.
• To determine if heparin levels in salvaged blood are sufficient to clinically influence activated clotting time.

Main Methods:

• A prospective, observational pilot study involving 12 patients undergoing cardiovascular surgery (May-October 2018).
• Collection of blood samples during heparinization and salvaged blood samples from three different cell salvage systems after protamine administration.
• Measurement of heparin concentration in all collected samples.

Main Results:

• Heparin concentrations in salvaged blood from two devices were below the limit of quantification (0.10 IU/mL).
• One device showed a mean measurable heparin concentration of 0.15 IU/mL in salvaged blood.
• No significant levels of heparin were detected that would clinically impact activated clotting time.

Conclusions:

• Salvaged blood during cardiovascular surgery, using the evaluated systems, does not contain clinically significant amounts of heparin.
• The practice of cell salvage is unlikely to interfere with anticoagulation management in these patients.
• Further studies with larger sample sizes may be warranted to confirm these findings across various devices and patient populations.