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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: thorsten.haas@i-med.ac.at; Tel: 43 512 504 22400; Fax: 43 512 504 22450
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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

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