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Related Experiment Videos

Whole blood versus packed-cell transfusions: a physiologic comparison

S R Shackford, R W Virgilio, R M Peters

    Annals of Surgery
    |March 1, 1981
    PubMed
    Summary

    Packed red blood cells (PRBC) effectively replace volume during major aortic reconstruction without causing coagulopathy. This blood product also avoids the significant drop in serum colloid osmotic pressure seen with whole blood (WB).

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    Area of Science:

    • Cardiovascular Surgery
    • Transfusion Medicine
    • Critical Care Medicine

    Background:

    • Major aortic reconstructions require significant blood replacement.
    • Whole blood (WB) and packed red blood cells (PRBC) are common transfusion options.
    • The physiological impact of these blood products on hemodynamics and coagulation requires careful evaluation.

    Purpose of the Study:

    • To compare the efficacy and physiological effects of WB versus PRBC for blood replacement in patients undergoing major aortic reconstructions.
    • To assess the impact of WB and PRBC on cardiac index, pulmonary function, and coagulation parameters.

    Main Methods:

    • Prospective randomized trial involving 28 patients undergoing major aortic reconstructions.
    • Patients were assigned to receive either WB or PRBC for blood replacement.

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  • Hemodynamic parameters (CI, PCWP), intrapulmonary shunt (Qs/Qt), serum colloid osmotic pressure (COP), and coagulation tests (PT, PTT, fibrinogen) were measured preoperatively, intraoperatively, and for three days postoperatively.

    • Main Results:

    • Postoperative cardiac index (CI) increased significantly in both groups but showed no significant difference between WB and PRBC.
    • Patients receiving PRBC experienced a significant decrease in postoperative serum colloid osmotic pressure (COP) and COP-PCWP gradient, which was not observed in the WB group.
    • No significant differences in intrapulmonary shunt (Qs/Qt) or evidence of pulmonary dysfunction were found between the groups.
    • Both groups showed transient prolongation of prothrombin time (PT) and partial thromboplastin time (PTT) immediately post-operation, which resolved by day one.

    Conclusions:

    • Blood replacement with reconstituted PRBC provides effective volume replacement during major aortic reconstructions without inducing coagulopathy.
    • Observed decreases in COP and COP-PCWP gradient in the PRBC group did not lead to significant physiological or clinical pulmonary dysfunction.
    • PRBC transfusion is a safe and effective alternative to WB for volume replacement in this patient population.