HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tjark Ebels Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Haan, J. Articles by van Oeveren, W. Search for Related Content PubMed PubMed Citation Articles by de Haan, J. Articles by van Oeveren, W.

Ann Thorac Surg 1995;59:901-907
© 1995 The Society of Thoracic Surgeons

Retransfusion of Suctioned Blood During Cardiopulmonary Bypass Impairs Hemostasis

Department of Cardiothoracic Surgery and Cardiothoracic Surgery Research Division, University Hospital Groningen, Groningen, the Netherlands

Accepted for publication December 15, 1994.

In a previous study we observed extensive clotting and fibrinolysis in blood from the thoracic cavities during cardiopulmonary bypass. We hypothesized that retransfusion of this suctioned blood could impair hemostasis. In this prospective clinical study we investigated the effect of suctioned blood retransfusion on systemic blood activation and on postoperative hemostasis. During coronary artery bypass grafting in 40 patients, suctioned blood was collected separately. It then was retransfused to the patient at the end of the operation (n = 19), or it was retained (n = 21). During the study, 12 consecutive patients, randomized in two groups of 6, were analyzed for biochemical parameters indicating blood activation and clotting. The immediate and significant increase in circulating concentrations of thrombin-antithrombin III complex, tissue-type plasminogen activator, fibrin degradation products, and free plasma hemoglobin demonstrated the effect of suctioned blood retransfusion. Moreover, the increased concentrations of thrombin-antithrombin III complex and fibrin degradation products indicated renewed systemic clotting and fibrinolysis as a direct result of the retransfusion of suctioned blood. Concentrations of all indicators mentioned remained significantly lower in the retainment group. The clinical data showed that retainment of suctioned blood resulted in significantly decreased postoperative blood loss (822 mL in the retransfusion group versus 611 mL in the retainment group; p < 0.05) and similar or even reduced consumption of blood products (513 versus 414 mL red blood cell concentrate and 384 versus 150 mL single-donor plasma; both not significant). We conclude that retransfusion of highly activated suctioned blood during cardiopulmonary bypass exacerbates wound bleeding.

This article has been cited by other articles:

				P. Raivio, R. Lassila, and J. Petaja Thrombin in myocardial ischemia-reperfusion during cardiac surgery. Ann. Thorac. Surg., July 1, 2009; 88(1): 318 - 325. [Abstract] [Full Text] [PDF]

				A. Castiglioni, A. Verzini, N. Colangelo, S. Nascimbene, G. Laino, and O. Alfieri Comparison of minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement: a randomized study Interactive CardioVascular and Thoracic Surgery, July 1, 2009; 9(1): 37 - 41. [Abstract] [Full Text] [PDF]

				M. Boodhwani, H. J. Nathan, T. G. Mesana, F. D. Rubens, and Cardiotomy Investigators Effects of Shed Mediastinal Blood on Cardiovascular and Pulmonary Function: A Randomized, Double-Blind Study Ann. Thorac. Surg., October 1, 2008; 86(4): 1167 - 1173. [Abstract] [Full Text] [PDF]

				O. Fabre, A. Vincentelli, D. Corseaux, F. Juthier, S. Susen, A. Bauters, E. Van Belle, F. Mouquet, T. Le Tourneau, C. Decoene, et al. Comparison of Blood Activation in the Wound, Active Vent, and Cardiopulmonary Bypass Circuit Ann. Thorac. Surg., August 1, 2008; 86(2): 537 - 541. [Abstract] [Full Text] [PDF]

				W. J. Vermeijden, A. Hagenaars, W. van Oeveren, and A. J. de Vries Do repeated runs of a cell saver device increase the pro-inflammatory properties of washed blood? Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 350 - 353. [Abstract] [Full Text] [PDF]

				E De Stefano, D Delay, J Horisberger, and L. von Segesser Initial clinical experience with the admiral oxygenator combined with separated suction Perfusion, July 1, 2008; 23(4): 209 - 213. [Abstract] [PDF]

				P. Raivio, J. Petaja, A. Kuitunen, and R. Lassila Thrombophilic Variables Do Not Increase the Generation or Procoagulant Activity of Thrombin During Cardiopulmonary Bypass Ann. Thorac. Surg., February 1, 2008; 85(2): 536 - 542. [Abstract] [Full Text] [PDF]

				F. D. Rubens, M. Boodhwani, T. Mesana, D. Wozny, G. Wells, H. J. Nathan, and on behalf of the Cardiotomy Investigators The Cardiotomy Trial: A Randomized, Double-Blind Study to Assess the Effect of Processing of Shed Blood During Cardiopulmonary Bypass on Transfusion and Neurocognitive Function Circulation, September 11, 2007; 116(11_suppl): I-89 - I-97. [Abstract] [Full Text] [PDF]

				J. M. van den Goor, R. Nieuwland, P. M. Rutten, J. G. Tijssen, C. Hau, A. Sturk, L. Eijsman, and B. A. de Mol Retransfusion of pericardial blood does not trigger systemic coagulation during cardiopulmonary bypass Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1029 - 1036. [Abstract] [Full Text] [PDF]

				F. D. Rubens and H. Nathan Lessons learned on the path to a healthier brain: dispelling the myths and challenging the hypotheses Perfusion, May 1, 2007; 22(3): 153 - 160. [Abstract] [PDF]

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

				A. Castiglioni, A. Verzini, F. Pappalardo, N. Colangelo, L. Torracca, A. Zangrillo, and O. Alfieri Minimally Invasive Closed Circuit Versus Standard Extracorporeal Circulation for Aortic Valve Replacement Ann. Thorac. Surg., February 1, 2007; 83(2): 586 - 591. [Abstract] [Full Text] [PDF]

				K. G. Shann, D. S. Likosky, J. M. Murkin, R. A. Baker, Y. R. Baribeau, G. R. DeFoe, T. A. Dickinson, T. J. Gardner, H. P. Grocott, G. T. O'Connor, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 283 - 290.e3. [Full Text] [PDF]

				M. Westerberg, J. Gabel, A. Bengtsson, J. Sellgren, O. Eidem, and A. Jeppsson Hemodynamic effects of cardiotomy suction blood J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1352 - 1357. [Abstract] [Full Text] [PDF]

				E. Sirvinskas, A. Veikutiene, P. Grybauskas, J. Cimbolaityte, A. Mongirdiene, V. Veikutis, and L. Raliene Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery Perfusion, January 1, 2006; 21(1): 61 - 66. [Abstract] [PDF]

				M J ten Brinke, P W Weerwind, S Teerenstra, J C. Feron, W van der Meer, and M H. Brouwer Leukocyte removal efficiency of cell-washed and unwashed whole blood: an in vitro study Perfusion, December 1, 2005; 20(6): 335 - 341. [Abstract] [PDF]

				D Belway, F D Rubens, D Wozny, B Henley, and H J Nathan Are we doing everything we can to conserve blood during bypass? A national survey Perfusion, September 1, 2005; 20(5): 237 - 241. [Abstract] [PDF]

				A. Shander, D. Moskowitz, and T. S. Rijhwani The Safety and Efficacy of "Bloodless" Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 53 - 63. [Abstract] [PDF]

				E. Sirvinskas, T. Lenkutis, L. Raliene, A. Veikutiene, J. Vaskelyte, and I. Marchertiene Influence of residual blood autotransfused from cardiopulmonary bypass circuit on clinical outcome after cardiac surgery Perfusion, March 1, 2005; 20(2): 71 - 75. [Abstract] [PDF]

				M. Westerberg, A. Bengtsson, and A. Jeppsson Coronary surgery without cardiotomy suction and autotransfusion reduces the postoperative systemic inflammatory response Ann. Thorac. Surg., July 1, 2004; 78(1): 54 - 59. [Abstract] [Full Text] [PDF]

				F D Rubens and T Mesana The inflammatory response to cardiopulmonary bypass: a therapeutic overview Perfusion, January 1, 2004; 19(1_suppl): S5 - S12. [Abstract] [PDF]

				S. Dial, D. Nguyen, and D. Menzies Autotransfusion of Shed Mediastinal Blood: A Risk Factor for Mediastinitis After Cardiac Surgery? Results of a Cluster Investigation Chest, November 1, 2003; 124(5): 1847 - 1851. [Abstract] [Full Text] [PDF]

				C R Daane, H D Golab, J H. Meeder, M J Wijers, and A J. Bogers Processing and transfusion of residual cardiopulmonary bypass volume: effects on haemostasis, complement activation, postoperative blood loss and transfusion volume Perfusion, March 1, 2003; 18(2): 115 - 121. [Abstract] [PDF]

				R. Salenger, J. S. Gammie, and T. J. Vander Salm Postoperative Care of Cardiac Surgical Patients Card. Surg. Adult, January 1, 2003; 2(2003): 439 - 469. [Full Text]

				M. Johnell, G. Elgue, R. Larsson, A. Larsson, S. Thelin, and A. Siegbahn Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface J. Thorac. Cardiovasc. Surg., August 1, 2002; 124(2): 321 - 332. [Abstract] [Full Text] [PDF]

				F. De Somer, Y. Van Belleghem, F. Caes, K. Francois, H. Van Overbeke, J. Arnout, Y. Taeymans, and G. Van Nooten Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., May 1, 2002; 123(5): 951 - 958. [Abstract] [Full Text] [PDF]

				K. J Lilly, P. J O'Gara, P. R Treanor, R. Crowley, D. L Reardon, O. M Shapira, S. F Khuri, G. S Aldea, and R. J Shemin Heparin-bonded circuits without a cardiotomy: a description of a minimally invasive technique of cardiopulmonary bypass Perfusion, March 1, 2002; 17(2): 95 - 97. [Abstract] [PDF]

				T Amand, J Pincemail, F Blaffart, R Larbuisson, R Limet, and J O Defraigne Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit Perfusion, March 1, 2002; 17(2): 117 - 123. [Abstract] [PDF]

				F De Somer, Y Van Belleghem, F Caes, K Francois, J Arnout, X Bossuyt, Y Taeymans, and G Van Nooten Phosphorylcholine coating offers natural platelet preservation during cardiopulmonary bypass Perfusion, January 1, 2002; 17(1): 39 - 44. [Abstract] [PDF]

				A Pierangeli, V Masieri, F Bruzzi, E De Toni, G Grillone, P Boni, and A Delnevo Haemolysis during cardiopulmonary bypass: how to reduce the free haemoglobin by managing the suctioned blood separately Perfusion, December 1, 2001; 16(6): 519 - 524. [Abstract] [PDF]

				G. J. Despotis, M. S. Avidan, and C. W. Hogue Jr Mechanisms and attenuation of hemostatic activation during extracorporeal circulation Ann. Thorac. Surg., November 1, 2001; 72(5): S1821 - 1831. [Abstract] [Full Text] [PDF]

				N. J. Skubas and G. J. Despotis Optimal Management of Bleeding Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 217 - 228. [Abstract] [PDF]

				W. Reents, J. Babin-Ebell, and O. Elert Remaining procoagulant property of wound blood washed by a cell-saving device: Reply Ann. Thorac. Surg., May 1, 2001; 71(5): 1749 - 1750. [Full Text] [PDF]

				J. Martin, D. Robitaille, L. P. Perrault, M. Pellerin, P. Page, N. Searle, R. Cartier, Y. Hebert, L. C. Pelletier, H. T. Thaler, et al. Reinfusion of mediastinal blood after heart surgery J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 499 - 504. [Abstract] [Full Text] [PDF]

				K. N. Maquelin, R. Nieuwland, E. G. W. M. Lentjes, A. N. Boing, B. Mochtar, L. Eijsman, and A. Sturk Aprotinin administration in the pericardial cavity does not prevent platelet activation J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 552 - 557. [Abstract] [Full Text] [PDF]

				G. J. Despotis and L. T. Goodnough Management approaches to platelet-related microvascular bleeding in cardiothoracic surgery Ann. Thorac. Surg., August 1, 2000; 70(2): S20 - 32. [Abstract] [Full Text] [PDF]

				H. I. Flom-Halvorsen, E. Ovrum, G. Tangen, F. Brosstad, M.-A. L. Ringdal, and R. Oystese AUTOTRANSFUSION IN CORONARY ARTERY BYPASS GRAFTING: DISPARITY IN LABORATORY TESTS AND CLINICAL PERFORMANCE J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 610 - 617. [Abstract] [Full Text] [PDF]

				W. Reents, J. Babin-Ebell, M. R. Misoph, A. Schwarzkopf, and O. Elert Influence of different autotransfusion devices on the quality of salvaged blood Ann. Thorac. Surg., July 1, 1999; 68(1): 58 - 62. [Abstract] [Full Text] [PDF]

				H. Philippou, S. J. Davidson, M. T. Mole, J. R. Pepper, J. F. Burman, and D. A. Lane Two-Chain Factor VIIa Generated in the Pericardium During Surgery With Cardiopulmonary Bypass : Relationship to Increased Thrombin Generation and Heparin Concentration Arterioscler. Thromb. Vasc. Biol., February 1, 1999; 19(2): 248 - 254. [Abstract] [Full Text] [PDF]

				Y. J. Gu, P. W. Boonstra, A. A. Rijnsburger, J. Haan, and W. van Oeveren Cardiopulmonary Bypass Circuit Treated With Surface-Modifying Additives: A Clinical Evaluation of Blood Compatibility Ann. Thorac. Surg., May 1, 1998; 65(5): 1342 - 1347. [Abstract] [Full Text] [PDF]

				K. N. Maquelin, R. J. Berckmans, R. Nieuwland, M. C. L. Schaap, K. ten Have, L. Eijsman, and A. Sturk Disappearance of glycoprotein Ib from the platelet surface in pericardial blood during cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., May 1, 1998; 115(5): 1160 - 1165. [Abstract] [Full Text] [PDF]

				G. J. Despotis, J. H. Joist, and L. T. Goodnough Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes Clin. Chem., September 1, 1997; 43(9): 1684 - 1696. [Abstract] [Full Text] [PDF]

				M. Ernofsson, S. Thelin, and A. Siegbahn MONOCYTE TISSUE FACTOR EXPRESSION, CELL ACTIVATION, AND THROMBIN FORMATION DURING CARDIOPULMONARY BYPASS: A CLINICAL STUDY J. Thorac. Cardiovasc. Surg., March 1, 1997; 113(3): 576 - 584. [Abstract] [Full Text]

				Y. J. Gu, J. de Haan, U. P. M. Brenken, W. J. de Boer, Jm. Prop, W. van Oeveren, and G. L. T. Group CLOTTING AND FIBRINOLYTIC DISTURBANCE DURING LUNG TRANSPLANTATION: EFFECT OF LOW-DOSE APROTININ J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 599 - 606. [Abstract] [Full Text]

				D. D. Muehrcke, P. M. McCarthy, K. Kottke-Marchant, H. Harasaki, J. Pierre-Yared, J. A. Borsh, D. A. Ogella, and D. M. Cosgrove BIOCOMPATIBILITY OF HEPARIN-COATED EXTRACORPOREAL BYPASS CIRCUITS: A RANDOMIZED, MASKED CLINICAL TRIAL J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 472 - 483. [Abstract] [Full Text]

				D. Royston Systemic inflammatory responses to surgery with cardiopulmonary bypass Perfusion, May 1, 1996; 11(3): 177 - 189. [PDF]

				S. Daniel Review on the multifactorial aspects of bioincompatibility in CPB Perfusion, May 1, 1996; 11(3): 246 - 255. [Abstract] [PDF]

				C. Bartels, M. Bechtel, C. Winkler, and S. Horsch Quality of retransfused blood: whole blood versus cell separation. Ann. Thorac. Surg., January 1, 1996; 61(1): 279 - 280. [Full Text]