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

This Article Full Text (PDF) 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): Makoto Sunamori Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tabuchi, N. Articles by Shibamiya, A. Search for Related Content PubMed PubMed Citation Articles by Tabuchi, N. Articles by Shibamiya, A. Related Collections Cardiac - pharmacology Related Article

Ann Thorac Surg 2001;71:1749
© 2001 The Society of Thoracic Surgeons

---

Correspondence

Remaining procoagulant property of wound blood washed by a cell-saving device

^a Tokyo Medical and Dental University, Department of Cardiopulmonary Surgery, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
^b Tokyo Medical and Dental University, School of Allied Health Sciences, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

e-mail: n-tabu.tsrg{at}tmd.ac.jp

To the Editor

We read with interest the article by Reents and associates [1] describing the questionable quality of the wound blood washed by a cell-saving device. It is now known that blood cells [2] as well as plasma components [3] are activated in the pericardial cavity. Reents and associates [1] demonstrated that washing of the wound blood spared activated leukocytes and failed to completely remove proinflammatory cytokines. Activated monocytes, in particular, have recently been shown to express tissue factor (TF) on the surface when exposed to the pericardial cavity [2]. Therefore, we questioned whether the wound blood washed by a cell-saving device retains procoagulant properties because of activated monocytes spared during washing.

In 5 patients who underwent coronary bypass grafting operation, wound blood was collected and washed by a cell-saving device (Hemonetics CS4, Munich, Germany) for reinfusion. Blood samples were taken from the collected blood before and after washing; the arterial blood collected preoperatively served as a control. After the monocytes were isolated and the cell number in each aliquot was standardized (1 x 10⁵), the level of TF mRNA was determined by quantitative reverse transcription–polymerase chain reaction (RT-PCR) assays using the Titan One Tube RT-PCR Kit (Roche Diagnostics GmbH, Mannheim, Germany), and the relative signal intensity was standardized by using the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) signal, as described previously [4].

The TF to GAPDH mRNA ratio was 10 times higher in monocytes isolated from washed wound blood than it was in control monocytes (TF/GAPDH; 0.43 ± 0.2 [SD] vs 0.047 ± 0.07, p < 0.05) and was similar to the ratio in monocytes from unwashed blood (TF/GAPDH; 0.52 ± 0.2). The cell number of monocytes in unwashed blood decreased to almost 80%, and the cell number of monocytes in washed blood decreased to 70% of preoperative controls. Monocytes with increased levels of TF mRNA manifest procoagulant activity via the expression of TF on the cell surface [4]. Therefore, the reinfusion of the wound blood containing activated monocytes could produce a procoagulant state in the patient body. To reduce the likelihood of this harmful reaction, it might be of use to remove monocytes from the wound blood washed by a cell-saving device by using a leukocyte filter.

References

1. Reents W., Babin-Ebell J., Misoph M.R., Schwarzkopf A., Elert O. Influence of different autotransfusion devices on the quality of salvaged blood. Ann Thorac Surg 1999;68:58-62.[Abstract/Free Full Text]
2. Chung J.H., Gikakis N., Rao K., Drake T.A., Colman R.W., Edmunds L.H., Jr Pericardal blood activates the extrinsic coagulation pathway during clinical cardiopulmonary bypass. Circulation 1996;93:2014-2018.[Abstract/Free Full Text]
3. Tabuchi N., de Haan J., Boonstra P.W., van Oeveren W. Activation of fibrinolysis in the pericardial cavity during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1993;106:828-833.[Abstract]
4. Ohsawa M., Koyama T., Yamamoto K., Hirosawa S., Kamei S., Kamiyama R. 1,25-dihydroxyvitamin D₃ and its potent synthetic analogs downregulate tissue factor and upregulate thrombomodulin expression in monocytic cells counteracting the effects of tumor necrosis factor and oxidized low-density lipoprotein. Circulation 2000;102:2867-2872.[Abstract/Free Full Text]

This article has been cited by other articles:

				J. Wippermann, J. M. Albes, M. Hartrumpf, M. Kaluza, R. Vollandt, R. Bruhin, and T. Wahlers Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 127 - 132. [Abstract] [Full Text] [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]

This Article Full Text (PDF) 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): Makoto Sunamori Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tabuchi, N. Articles by Shibamiya, A. Search for Related Content PubMed PubMed Citation Articles by Tabuchi, N. Articles by Shibamiya, A. Related Collections Cardiac - pharmacology Related Article