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Sodium citrate effectively used in shed mediastinal blood autotransfusion after cardiac surgery
Xinghai Hao1, Yueling Chen2, Liangshan Wang1
1Cardiac Surgery Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Insights
Sodium citrate effectively enables autologous blood transfusion of shed mediastinal blood after cardiac surgery, reducing the need for allogeneic blood transfusions in patients experiencing postoperative hemorrhage.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Postoperative hemorrhage after cardiopulmonary bypass (CPB) is a significant concern.
- Heparin is the standard anticoagulant, but alternatives are sought for autologous blood transfusion.
- Shed mediastinal blood is a potential source for autotransfusion.
Purpose of the Study:
- To evaluate the efficacy and safety of sodium citrate as an anticoagulant for autologous shed mediastinal blood transfusion.
- To compare the outcomes of patients receiving autotransfusion with those undergoing standard care.
Main Methods:
- A study involving 93 patients undergoing cardiac surgery with CPB.
- Patients were divided into a control group (discarded shed blood) and a reinfusion group (washed autologous red cells).
- Sodium citrate (1.6% diluted) was used as an anticoagulant in the washing procedure of shed mediastinal blood.
Main Results:
- The reinfusion group required significantly fewer units of allogeneic blood (2.91 vs. 4.03 units).
- Postoperative hemoglobin and hematocrit levels were higher in the reinfusion group.
- Calcium ion concentration in shed mediastinal blood was low and further reduced after washing.
Conclusions:
- Sodium citrate is a viable alternative anticoagulant for autologous shed mediastinal blood transfusion post-CPB cardiac surgery.
- This method effectively reduces the requirement for allogeneic blood transfusions in bleeding patients.
Background:
We used sodium citrate as an alternative anticoagulation agent to heparin in the procedure of autologous blood transfusion with patients with postoperative haemorrhage after CPB. The aim of study was to evaluate the efficacy and safety of sodium citrate used in shed mediastinal blood autotransfusion after cardiac surgery.
Methods:
Ninety-three patients were divided into two groups in this study. In the control group, 52 patients' shed mediastinal blood was discarded. The reinfusion group consisted of 41 patients receiving a reinfusion of washed autologous red cells from shed mediastinal blood. Each 400 mL shed blood sample was anticoagulated by 140 mL of 1.6% diluted sodium citrate in the washing procedure using a blood recovery machine. Hemoglobin (Hb), hematocrit (Hct), and electrolyte concentrations in both the patients and shed mediastinal blood were measured before and after this procedure.
Results:
The mean volume of autotransfused shed blood was 239.5 ± 54.6 mL.The Hct of the washed red cells was 56.8 ± 6.1%. Significantly, fewer units of allogeneic blood were required per patient in the reinfusion group at 24 h postoperatively (2.91 ± 1.34 vs 4.03 ± 0.19 U, p = 0.002). At 24 h postoperatively, Hb and Hct levels were higher in the reinfusion group than in the control group. The calcium ion concentration was very low in the shed mediastinal blood, 0.25 ± 0.08 mmol/L, and was lower after washing, 0.15 ± 0.04 mmol/L.
Conclusions:
Sodium citrate, as an alternative anticoagulant agent, can be used in autologous shed mediastinal blood transfusion after CPB cardiac surgery. This procedure can effectively reduce the amount of allogeneic blood for patients with haemorrhage.
