Clinical outcome of transfusion processed by ultrafiltration in patients undergoing coronary bypass
Terence Gourlay1, Serdar Gunaydin2
1Bioenginering Unit, University of Strathclyde-UK; 2University of K. Kale, Turkey
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.
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).
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
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.
Centrifugation the blood values before and after processing using 5650rpm centrifuge speed and different wash pump rates
***P<0.001 vs values before processing
Results of coagulation parameter changes after administration of concentrated whole blood using the Hemobag
Results clinical follow up
This Clinical study and any others that may be added in the near future, can be downloaded here.