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Ann Thorac Surg 2001;71:1749-1750
© 2001 The Society of Thoracic Surgeons

Correspondence

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

Wilko Reents, MDa, Jörg Babin-Ebell, MDa, Olaf Elert, MDa

a Klinik und Poliklinik für Herz- und Thoraxchirurgie, Josef-Schneider-Str 6, D - 97080 Würzburg, Germany

To the Editor

Tabuchi and colleagues [1] found, that the content of tissue factor mRNA was 10-fold higher in monocytes gained from blood collected with a cell-saving device as compared to monocytes gained from preoperatively collected blood samples. As expected, the washing procedure did not influence the presumably intracellular concentration of tissue factor mRNA. These results support the assumption that an activation of leukocytes is present in the extravasal wound blood. Because blood salvage with a cell-saving device retains corpuscular blood elements including activated leukocytes, only a partial amelioration regarding the alterations of extravasal wound blood can be expected. It would be interesting to know whether the increased content of tissue factor mRNA was caused by the cardiopulmonary bypass (CPB) circuit or by the contact of monocytes to air, tissue, and the subsequent mechanical stress of the suction device.

There can be no doubt that every effort should be undertaken to minimize transfusion requirements, and this also includes the intraoperative salvage of extravasal wound blood. However, there is evidence that this salvaged blood shows marked alterations regarding coagulation, fibrinolysis, hemolysis, and proinflammatory cytokines [2, 3]; thus extravasal blood experience a certain "trauma." The impairment of coagulation and fibrinolysis and the systemic inflammatory response observed after surgery performed with CPB therefore will be influenced by the amount of retransfused wound blood. If processing this blood with a cell-saving device can be beneficial and cost-effective regarding clinical characteristics (eg, postoperative blood loss, transfusion requirements, preserved organ function) remains to be elucidated, and the same is true for the application of leukocyte filters. Yet, as stated above, a complete resolution of the "traumatic" alterations cannot be expected. Being aware of the "trauma" that occurs to extravasal wound blood, physicians should take every measure to avoid bleeding during surgery, and the possibility of blood salvage with the cardiotomy suction or a cell-saving device should not lead to a liberal handling. Another aspect is that studies investigating the effect of CPB may be flawed by intraoperative retransfusion of wound blood, and control of this confounding factor is necessary [4, 5].


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  1. Tabuchi N, Sunamori M, Koyama T, Shibamiya A. Remaining procoagulant property of wound blood washed by a cell-saving device[Letter] Ann Thorac Surg 2001;71:1749.[Free Full Text]
  2. De Haan J, Boonstra PW, Monnink SHJ, Ebels T, van Oeveren W. Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis Ann Thorac Surg 1995;59:901-907.[Abstract/Free Full Text]
  3. Reents W, Babin-Ebell J, Misoph MR, 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]
  4. Hansbro SD, Sharpe DA, Catchpole R, et al. Haemolysis during cardiopulmonary bypass. an in vivo comparison of standard roller pumps and centrifugal pumps. Perfusion 1999;14:3-10.[Abstract/Free Full Text]
  5. Anderson RE, Hansson LO, Liska J, Settergren G, Vaage J. The effect of cardiotomy suction on the brain injury marker S 100-β after cardiopulmonary bypass Ann Thorac Surg 2000;69:847-850.[Abstract/Free Full Text]



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