Clinical data

Clinical outcome of transfusion processed by ultrafiltration in patients undergoing coronary bypass

Abstract

Terence Gourlay1, Serdar Gunaydin2

1Bioenginering Unit, University of Strathclyde-UK; 2University of K. Kale, Turkey

Objective

Following termination of cardiopulmonary bypass (CPB), the circuit contains a significant volume of diluted blood and various methods have been used to salvage this blood including direct transfusion or centrifugation/washing of the circuit volume. We designed a prospective clinical trial to determine the clinical outcomes of transfusion of autologous blood processed by a novel ultrafiltration device (Hemosep Brightwake, Nottingham, UK) in high risk patients undergoing coronary re-vascularisation.

Patients & Methods

Over a 6-month period, 40 high risk patients (Euroscore 6+) undergoing CABG with full heparin dose strategy were prospectively randomised into 2 equal groups (N=20). In Group 1, following the cessation of CPB, salvaged blood in the venous reservoir was pumped into the Hemosep bag until the desired volume has been introduced and processed for re-transfusion back to the patients. Group 2 patients were controls and this technology was not employed. Blood samples were collected at baseline (T1); at the end of the CPB (T2) and 24 h (T3), postoperatively.

Results

Mean processed blood was 775±125mL.80% (N=16) patients in Group 1 and 30% (N=6) in control group did not receive any bank blood (p<0.05). Postoperative bleeding was 545±180 cc in Group 1 versus 725±200 cc in control (p<0.05). IL-6 levels (pg/ml) were significantly lower in Group 1 versus control at T3 (11±4 versus 32±8; p<0.05). CD11b/CD18 levels (%) were significantly lower in Group 1 (14±4) versus control (23±8) at T3 (p<0.05).

Conclusions

Use of the Hemosep device for salvaging blood is associated with significant decrease in post-CPB inflammatory response, postoperative bleeding and the need of transfusion with prevention of exposure to expensive and precarious allogeneic blood products.

Comparison with patient’s pre-operative blood

Ultrafiltration_1_Post Hemosep

Effect of Hemosep device on cell populations and haemoglobin. Comparison of pre-surgery and post-Hemosep blood samples. All factors were within 10% of “normal” pre-surgical levels with the exception of White Cell counts which were almost double the baseline levels in these patients. This is probably the result of well documented white cell dynamics associated with the deployment of cardiopulmonary bypass.

 Ultrafiltration_2_Haematocrit, WBC & Platelets

 Centrifugation the blood values before and after processing using 5650rpm centrifuge speed and different wash pump rates

Ultrafiltration_3_Centrifugation

 ***P<0.001 vs values before processing

Results of coagulation parameter changes after administration of concentrated whole blood using the Hemobag

Ultrafiltration_4_Results of coagulation parameter Legend: Coagulation parameter values for 12 patients receiving an average of 1046 ml of concentrated whole blood are listed with the results of t-test analysis between pre and post-administration.

Results clinical follow up

Ultrafiltration_5_Results clinical follow up

 

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