RETRANSFUSION OF SUCTIONED BLOOD DURING CARDIOPULMONARY BYPASS IMPAIRS HEMOSTASIS

In a previous study we observed extensive clotting and fibrinolysis in blood from the thoracic cavities during cardiopulmonary bypass. We hy pothesized that retransfusion of this suctioned blood could impair hem ostasis. In this prospective clinical study we investigated the effect of suctioned blood retransfusion on systemic blood activation and on postoperative hemostasis. During coronary artery bypass grafting in 40 patients, suctioned blood was collected separately. It then was retra nsfused to the patient at the end of the operation (n = 19), or it was retained (n = 21). During the study, 12 consecutive patients, randomi zed in two groups of 6, were analyzed for biochemical parameters indic ating blood activation and clotting. The immediate and significant inc rease in circulating concentrations of thrombin-antithrombin III compl ex, tissue-type plasminogen activator, fibrin degradation products, an d free plasma hemoglobin demonstrated the eff ect of suctioned blood r etransfusion. Moreover, the increased concentrations of thrombin-antit hrombin III complex and fibrin degradation products indicated renewed systemic clotting and fibrinolysis as a direct result of the retransfu sion of suctioned blood. Concentrations of all indicators mentioned re mained significantly lower in the retainment group. The clinical data showed that retainment of suctioned blood resulted in significantly de creased postoperative blood loss (822 mL in the retransfusion group ve rsus 611 mL in the retainment group; p < 0.05) and similar or even red uced consumption of blood products (513 versus 414 mL red blood cell c oncentrate and 384 versus 150 mL single-donor plasma; both not signifi cant). We conclude that retransfusion of highly activated suctioned bl ood during cardiopulmonary bypass exacerbates wound bleeding.