CYTOKINE AND COAGULATION CHARACTERISTICS OF RETRIEVED BLOOD AFTER ARTHROPLASTY

Objectives: To investigate cytokine and coagulation/fibrinolysis chara cteristics in blood retrieved from wounds using an autotransfusion sys tem, and to compare the cytokine pattern in the retrieved blood with t hose in the systemic circulation and in the initial portion of drainag e blood from the wound. Design: Prospective controlled clinical study. Setting: The postoperative ward of a University hospital. Patients an d participants: Blood retrieval was performed over a period of 4-6 h o n patients who had just undergone arthroplasty (nine hips, one knee). In five other cases involving hip arthroplasties, the initial portion of drainage blood was studied. Measurements and results: Coagulation/f ibrinolysis parameters were analyzed in blood retrieved using the Stry ker Consta Vac system. Concentrations of tumor necrosis factor alpha ( TNF), interleukin-1 beta (IL-1) and interleukin-6 (IL-6) were analyzed in the retrieved blood, in the systemic circulation of the patients a t the beginning and at the end of blood retrieval and in the initial p ortion of drainage blood from the surgical area. In the retrieved bloo d, the activities of thrombin, kallikrein and plasmin were increased, antithrombin and free protein S were decreased, and in all samples IL- 6 was > 1000 pg/ml. Postoperative plasma concentrations of IL-6 rose f rom a median value of 0 to 116 pg/ml (p<0.01). Four patients had circu lating TNF concentrations (range: <15-50 pg/ml). Plasma IL-1 was not d etected. TNF and IL-1 were detected in all samples of initial blood fr om the surgical area and IL-6 in one sample. Conclusion: Hypercoagulab ility and high concentrations of IL-6 were present in the retrieved bl ood. The cytokine pattern in the initial portion of blood from the sur gical area differed from those in the retrieved blood and in the syste mic circulation.