TRANSFUSION OF AUTOLOGOUS, HYDROXYETHYL STARCH-CRYOPRESERVED RED-BLOOD-CELLS

In this prospective, randomized study, we investigated the safety and efficacy of the transfusion of hydroxyethyl starch (HES) cryopreserved blood cells (RBC) com pared with the transfusion of liquid-stored RBC in patients undergoing major orthopedic or urologic surgery. Thirty-s ix patients donated autologous blood 35 +/- 6 days before elective sur gery. Only the first of 3.5 +/- 1.3 donated units of RBC was randomly assigned to be stored in the liquid state at 4 degrees C in hosphate/a denine/guanosine/glucose/saline-Mannitol or frozen below -130 degrees C by means of liquid nitrogen after the addition of HES (molecular wei ght 200,000 Dalton, degree of substitution 0.5, final concentration 11 .5% wt/wt) as a cryoprotectant. After induction of anesthesia, patient s donated 900 mt of autologous blood before they received one unit of liquid-stored RBC in Group 1. In Group 2, one unit of cryopreserved au tologous RBC was transfused after removal of the cryoprotectant HES. I n Group 3, patients received one unit of cryopreserved RBC without any manipulation after thawing. Patients in Groups 1 and 2 received addit ional 500 mL of 10% HES. Hemodynamic variables, arterial blood gases, plasma hemoglobin, and arterial lactate concentrations were measured a fter the induction of anesthesia, after hemodilution, and at 10-min in tervals after transfusion of the respective RBC concentrate over a per iod of 40 min. Skeletal muscle tissue oxygen tension was measured in t he quadriceps muscle using an automatically stepwise-driven oxygen par tial pressure electrode. We found no differences among groups concerni ng demographics, arterial blood gas values, and lactate concentrations and observed no adverse reactions after transfusion of the convention ally stored or cryopreserved RBC. Hemodynamic variables did not differ among groups, with the exception of an increased mean arterial blood pressure after the transfusion of cryopreserved unwashed RBC. In all g roups, the skeletal muscle tissue oxygen tension remained constant aft er hemodilution and increased after transfusion of either washed or un washed cryopreserved RBC Although the free plasma hemoglobin concentra tion remained constant after the transfusion of liquid-stored RBC (26 +/- 8 mg/dL) the plasma hemoglobin concentration increased twofold aft er the transfusion of cryopreserved washed RBC (60 +/- 12 mg/dL) and t hreefold after transfusion of cryopreserved unwashed RBC (98 +/- 20 mg /dL). The authors conclude that transfusion of one unit of RBC after c ryopreservation with HES is safe and well tolerated by patients. Intra vascular volume replacement and skeletal muscle oxygenation characteri stics by erythrocytes did not differ between liquid-stored and cryopre served RBC. Implications: This study examined whether a colloid should be used to store blood. Our data suggest that the transfusion of one unit of red blood cells after cryopreservation with hydroxyethyl starc h is safe and well tolerated by patients. The effects of intravascular volume replacement and skeletal muscle oxygenation provided by red bl ood cells after liquid storage or cryopreservation were not different.