Clinical implications of procoagulant and leukoattractant formation during intraoperative blood salvage

Experiments using 21 dogs and red cell salvage equipment (Haemonetics Cell Saver, Haemonetics Corp, Braintree, Mass) were employed to study the formation and potency of procoagulant and leukoattractant material during experimental autologous blood salvage. Washed red cell suspensions were found to include toxic degradation products that had been released from a deposit of platelets and white cells adherent to the centrifuge bowl wall. When reinfused, these toxic products resulted in a "salvaged blood syndrome" of intravascular clotting and pulmonary damage. The pulmonary arterioles showed leukocyte margination and tangled fibrin skeins with occlusive thrombi. Intra-alveolar and perivascular hemorrhages, along with extensive pulmonary edema, were also observed. The formation of procoagulant and leukoattractant material could be markedly decreased when the red cell salvage technique incorporated the following precautions: (1) minimal dilution with saline (normal plasma protein levels), (2) a low calcium level, and (3) minimal platelet activation (avoidance of the aspiration of clotted blood just before processing).