EVALUATION OF LABORATORY COAGULATION AND LYTIC PARAMETERS RESULTING FROM AUTOLOGOUS WHOLE-BLOOD TRANSFUSION DURING PRIMARY AORTOCORONARY ARTERY BYPASS-GRAFTING

Study Objective: To determine if autologous blood reinfusion influence s overall hemostatic function following aortocoronary artery bypass gr aft (CABG) surgery, and if so, where the predominant area of this infl uence lies. Design: Prospective, with control values on each patient. Setting: Cardiac operating room of a major university-affiliated count y hospital. Patients: 20 patients undergoing elective CABG surgery. In terventions: Following heparinization, and prior to cardiopulmonary by pass (CPB), venous blood (average 4.9 ml/kg) was removed via an indwel ling interval jugular catheter into a preservative-free plastic transf er pack unit and stored without agitation at room temperature. This au tologous whole blood was reinfused after systemic protamine reversal o f heparin. Blood samples for analysis were drawn immediately before an d 5 minutes after completion of the reinfusion. Measurements and Main Results: Autologous blood reinfusion appears to be significantly relat ed to increased hemoglobin, hematocrit, platelet count, fibrinogen, pl asminogen, and antiplasmin levels. The prothrombin time and activated partial thromboplastin times decreased significantly, whereas activate d clotting times and D-dimer levels were unchanged. Significant increa ses occurred in the following thromboelastography parameters: maximum amplitude, amplitude 60 minutes after the maximum amplitude, and whole blood clot lysis index. Reaction time and coagulation time were not s tatistically different from control values. Conclusions: Significant i mprovements in coagulation and lytic parameters occur following CPB af ter the infusion of autologous blood. These improvements in coagulatio n indices may be the result of the infused blood or hemoconcentration, which is also known to occur during this period. Additional control s tudies are needed to differentiate these effects.