Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-02T20:12:07.471Z Has data issue: false hasContentIssue false
  • English
  • Français

Re-transfusion of salvaged washed red cells improves clot formation in pigs as measured by rotational thrombelastometry (ROTEM®)

Published online by Cambridge University Press:  01 June 2008

T. Haas ,
P. Innerhofer ,
A. Klingler ,
H. Wagner-Berger ,
C. Velik-Salchner ,
W. Streif  and
D. Fries
T. Haas*
Affiliation:
Innsbruck Medical University, Department of Anaesthesiology and Critical Care Medicine, Anichstrasse, Innsbruck, Austria
P. Innerhofer
Affiliation:
Innsbruck Medical University, Department of Anaesthesiology and Critical Care Medicine, Anichstrasse, Innsbruck, Austria
A. Klingler
Affiliation:
Innsbruck Medical University, Department of Theoretical Surgery Unit, Anichstrasse, Innsbruck, Austria
H. Wagner-Berger
Affiliation:
Innsbruck Medical University, Department of Anaesthesiology and Critical Care Medicine, Anichstrasse, Innsbruck, Austria
C. Velik-Salchner
Affiliation:
Innsbruck Medical University, Department of Anaesthesiology and Critical Care Medicine, Anichstrasse, Innsbruck, Austria
W. Streif
Affiliation:
Innsbruck Medical University, Department of Paediatrics, Anichstrasse, Innsbruck, Austria
D. Fries
Affiliation:
Innsbruck Medical University, Department of General and Surgical Critical Care Medicine, Anichstrasse, Innsbruck, Austria
*
Correspondence to: Thorsten Haas, Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. E-mail: [email protected]; Tel: 43 512 504 22400; Fax: 43 512 504 22450
Get access

Summary

Background and objective

Patients exhibiting considerable blood loss are prone to develop dilutional coagulopathy following volume supply. In such patients, in addition to transfusing stored blood components, cell saver systems are used to minimize allogeneic transfusion. Since red cell transfusion might influence the haemostatic system by further dilution, we investigated the effects of re-transfusion of salvaged washed red blood cells on the haemostatic process in an animal model of controlled haemorrhage using rotational thrombelastometry (ROTEM®; Pentapharm Co., Munich, Germany).

Methods

Anaesthetized pigs (n = 20) developed coagulopathy following haemorrhagic shock (withdrawal of 66% of estimated blood volume) and volume resuscitation with 6% hydroxyethyl starch 130/0.4. The shed blood was processed in a Cellsaver device (CATS ®; Fresenius AG, Bad Homburg, Germany), and the resulting salvaged red blood cells were re-transfused. ROTEM assays were performed at baseline, after blood loss, after volume resuscitation and following re-transfusion of salvaged red blood cells.

Results

As compared with baseline, blood loss and subsequent volume resuscitation resulted in significantly increased median values of clotting time (CT: 47.0, 5 .3 and 103.5 s), and clot formation time (CFT: 36.0, 40.0 and 186.0 s), whigggle maximum clot firmness decreased (MCF: 72.0, 68.5 and 39.5 mm). After re-transfusion of salvaged red blood cells (805 ± 175 mL) all these parameters improved (CT: 80.5 s; P = 0.05, CFT: 144.0 s; P = 0.0008, MCF: 42.0 mm; P = 0.0019) although baseline values were not reached.

Conclusion

In the case of extreme isovolaemic haemodilution, increasing the circulating red cell mass by re-transfusing salvaged red blood cells did not worsen the findings of dilutional coagulopathy but interestingly, at least partially, improves the clot formation process.

Keywords

BLOOD TRANSFUSIONCOAGULATIONBLOOD TRANSFUSION AUTOLOGOUSTHROMBOELASTOGRAPHY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 6 , June 2008 , pp. 473 - 478
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hardy, JF, de Moerloose, P, Samama, CM. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anaesth 2006; 53: S40–S58.CrossRefGoogle ScholarPubMed
2.Huet, C, Salmi, LR, Fergusson, D, Koopman-van Gemert, AW, Rubens, F, Laupacis, A. A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery. International Study of Perioperative Transfusion (ISPOT) Investigators. Anesth Analg 1999; 89: 861–869.Google Scholar
3.Karger, R, Kretschmer, V. Modern concepts of autologous haemotherapy. Transfus Apheresis Sci 2005; 32: 185–196.CrossRefGoogle ScholarPubMed
4.Murray, DJ, Gress, K, Weinstein, SL. Coagulopathy after reinfusion of autologous scavenged red blood cells. Anesth Analg 1992; 75: 125–129.CrossRefGoogle ScholarPubMed
5.Duke, WW. The relation of blood platelets to hemorrhagic disease. JAMA 1983; 250: 1201–1209.CrossRefGoogle ScholarPubMed
6.Cadroy, Y, Hanson, SR. Effects of red blood cell concentration on hemostasis and thrombus formation in a primate model. Blood 1990; 75: 2185–2193.CrossRefGoogle Scholar
7.Coller, BS, Springer, KT, Beer, JH et al. Thromboerythrocytes. In vitro studies of a potential autologous, semi-artificial alternative to platelet transfusions. J Clin Invest 1992; 89: 546–555.CrossRefGoogle ScholarPubMed
8.Escolar, G, Garrido, M, Mazzara, R, Castillo, R, Ordinas, A. Experimental basis for the use of red cell transfusion in the management of anemicthrombocytopenic patients. Transfusion 1988; 28: 406–411.CrossRefGoogle ScholarPubMed
9.Hellem, A, Borchgrevink, C, Ames, S. The role of red cells in hemostasis: the relation between Hct, BT and platelet adhesiveness. Br J Haematol 1961; 7: 42–50.CrossRefGoogle Scholar
10.Peyrou, V, Lormeau, JC, Herault, JP, Gaich, C, Pfliegger, AM, Herbert, JM. Contribution of erythrocytes to thrombin generation in whole blood. Thromb Haemost 1999; 81: 400–406.CrossRefGoogle ScholarPubMed
11.Velik-Salchner, C, Schnurer, C, Fries, D et al. Normal values for thrombelastography (ROTEM®) and selected coagulation parameters in porcine blood. Thromb Res 2005; 117: 597–602.CrossRefGoogle ScholarPubMed
12.Hartert, H. Thrombelastography, a method for physical analysis of blood coagulation. Z Gesamte Exp Med 1951; 117: 189–203.CrossRefGoogle ScholarPubMed
13.Luddington, RJ. Thrombelastography/thromboelastometry. Clin Lab Haematol 2005; 27: 81–90.CrossRefGoogle ScholarPubMed
14.Miller, BE, Guzzetta, NA, Tosone, SR, Levy, JH. Rapid evaluation of coagulopathies after cardiopulmonary bypass in children using modified thromboelastography. Anesth Analg 2000; 90: 1324–1330.CrossRefGoogle ScholarPubMed
15.Murray, DJ, Olson, J, Strauss, R, Tinker, JH. Coagulation changes during packed red cell replacement of major blood loss. Anesthesiology 1988; 69: 839–845.CrossRefGoogle ScholarPubMed
16.Burman, JF, Westlake, AS, Davidson, SJ et al. Study of five cell salvage machines in coronary artery surgery. Transfus Med 2002; 12: 173–179.CrossRefGoogle ScholarPubMed
17.Martini, WZ, Chinkes, DL, Pusateri, AE et al. Acute changes in fibrinogen metabolism and coagulation after hemorrhage in pigs. Am J Physiol Endocrinol Metab 2005; 289: 930–934.CrossRefGoogle ScholarPubMed
18.Singbartl, K, Innerhofer, P, Radvan, J et al. Hemostasis and hemodilution: a quantitative mathematical guide for clinical practice. Anesth Analg 2003; 96: 929–935.CrossRefGoogle ScholarPubMed
19.Lorentz, A, Waibel, H, Becker, P, Bender, J, Nebe, TC. Routine automated laboratory methods are inadequate to determine the number of platelets in blood salvaged and processed for autotransfusion. Infusion Ther Transfus Med 2000; 27: 33–36.Google Scholar
20.Scholz, M, Serrick, CJ, Noel, D, Singh, O, Melo, A. A prospective comparison of the platelet sequestration ability of three autotransfusion devices. J Extra Corpor Technol 2005; 37: 286–289.CrossRefGoogle ScholarPubMed
21.Valeri, CR, Cassidy, G, Pivacek, LE et al. Anemia-induced increase in the bleeding time: implications for treatment of nonsurgical blood loss. Transfusion 2001; 41: 977–983.CrossRefGoogle ScholarPubMed
22.Uijttewaal, WS, Nijhof, EJ, Bronkhorst, PJ, Den Hartog, E, Heethaar, RM. Near-wall excess of platelets induced by lateral migration of erythrocytes in flowing blood. Am J Physiol 1993; 264: 1239–1244.Google ScholarPubMed
23.Iwata, H, Kaibara, M, Dohmae, N, Takio, K, Himeno, R, Kawakami, S. Purification, identification, and characterization of elastase on erythrocyte membrane as factor IX-activating enzyme. Biochem Biophys Res Commun 2004; 316: 65–70.CrossRefGoogle ScholarPubMed
24.Rivard, GE, Brummel-Ziedins, KE, Mann, KG, Fan, L, Hofer, A, Cohen, E. Evaluation of the profile of thrombin generation during the process of whole blood clotting as assessed by thrombelastography. J Thromb Haemost 2005; 3: 2039–2043.CrossRefGoogle ScholarPubMed
25.Iselin, BM, Willimann, PF, Seifert, B et al. Isolated reduction of haematocrit does not compromise in vitro blood coagulation. Br J Anaesth 2001; 87: 246–249.CrossRefGoogle Scholar
26.Ruttmann, TG, Roche, AM, Gasson, J, James, MF. The effects of a one unit blood donation on auto-haemodilution and coagulation. Anaesth Intensive Care 2003; 31: 40–43.CrossRefGoogle ScholarPubMed
27.Velik-Salchner, C, Haas, T, Innerhofer, P et al. The effect of fibrinogen concentrate on thrombocytopenia. J Thromb Haemost 2007; 5: 1019–1025.CrossRefGoogle ScholarPubMed
28.Fries, D, Haas, T, Klingler, A et al. Efficacy of fibrinogen and prothrombin complex concentrate used to reverse dilutional coagulopathy – a porcine model. Br J Anaesth 2006; 97: 460–467.CrossRefGoogle ScholarPubMed
29.Thyes, C, Madjdpour, C, Frascarolo, P et al. Effect of high- and low-molecular-weight low-substituted hydroxyethyl starch on blood coagulation during acute normovolemic hemodilution in pigs. Anesthesiology 2006; 105: 1228–1237.CrossRefGoogle ScholarPubMed
30.Madjdpour, C, Dettori, N, Frascarolo, P et al. Molecular weight of hydroxyethyl starch: is there an effect on blood coagulation and pharmacokinetics? Br J Anaesth 2005; 94: 569–576.CrossRefGoogle ScholarPubMed