QUALITY OF WASHED SALVAGED RED-BLOOD-CELLS DURING TOTAL HIP-REPLACEMENT - A COMPARISON BETWEEN THE USE OF HEPARIN AND CITRATE AS ANTICOAGULANTS

A randomized, prospective study comparing heparin with citrate (ACD) a s anticoagulant during red blood cell saving was performed in 10 ASA g rade I-Il patients undergoing primary total hip replacement. Blood sam ples were taken before and after surgery and at several steps during c ell saving. In the heparin group, salvaged red cells showed normal val ues, with the exception of decreased filtrability and moderate hemolys is. More differences in red cell quality were found in the ACD group. Mean corpuscular volume was higher (110 vs 95 x 10-(12) mL), red cell distribution was increased (17% vs 13%), osmotic resistance was lower (0.54 vs 0.43 g NaCl/L at 50% hemolysis), antioxidative reserve capaci ty was lower (1.9 vs 4.6 U glutathione reductase per gram of hemoglobi n) and there was more hemolysis (15% vs 11%). Despite the small volume of autologous blood retransfused (388 +/- 92 mL), the differences in vitro produced significantly higher free hemoglobin levels in the pati ents' plasma at the end of the operation (58 vs 23 mg/dL). We conclude that heparin is preferable to citrate as an anticoagulant during auto transfusion with cell washing and immediate retransfusion.