Original Article

Qualitative Assessment of Shed Mediastinal Blood

Department of Thoracic and Cardiovascular Surgery and Division of Transfusion Medicine, Inselspital, Berne, Switzerland

^* Address correspondence to: Ulrike Volken, Department of Thoracic and Cardiovascular Surgery, Inselspital, CH-3010 Berne, Switzerland.

Abstract

In a randomized prospective study of patients undergoing coronary bypass surgery, autologous blood from chest drainage was collected and retransfused into 10 patients (RTX) whereas 10 patients without retransfusion served as controls. There was no significant difference referring to age, weight, height, perfusion time, and number of distal anastomosis. Our main regard was directed to a qualitative analysis of the retransfused autologous blood. Results (mean values ± 1 SD/patient): one; there was no bacterial contamination in the shed mediastinal blood just prior to retransfusion, two; elevated levels of free plasma hemoglobin (otolidin-method) were encountered after one hour on cardiopulmonary bypass (CPB) and a six-fold increase in the shed mediastinal blood from the cardiotomy reservoir (211 ± 44 mg/dl), three; the potassium value in the cardiotomy reservoir was slightly increased (5.8 ± 2.9 mmol/l), four, in no case was hemoglobinuria or coagulation disfunction noted (the activated clotting time (ACT) after retransfusion did not change significantly ( 117 ± 15 sec) as compared to preoperative values (112 ± 16 sec)) five; no evidence for further complement activation (determined by C3a and C5b-9), induced by CPB, was seen, and six; red cell adenosine-triphosphate (ATP) in the shed mediastinal blood was lowered to 2.56 ± 0.78 umol/gHb whereas red cell 2,3diphosphoglycerate (2,3DPG) remained normal.

On the basis of these results we consider the retransfusion of shed mediastinal blood following cardiac surgery a simple and safe method of blood salvage.