UNWASHED WOUND DRAINAGE BLOOD - WHAT ARE WE GIVING OUR PATIENTS

Wound drainage blood was collected after total joint arthroplasty was completed in 13 consecutive patients, Peripheral blood samples were co llected in the recovery room and at 6 hours postoperatively for all 13 patients. A standard enzyme-linked immunosorbency assay was done to q uantify tumor necrosis factor-alpha, interleukin-1 alpha, interleukin- 6, and interleukin-8 levels in the samples. At 6 hours postoperatively , the levels of cytokines were elevated significantly in the periphera l and drainage blood serum, In particular, the drainage blood serum ha d the most dramatic increase for all cytokines, which was significant, Reinfusion of unwashed filtered postoperative wound drainage blood ha s been shown not to be entirely benign; pyrogenic transfusion reaction is the most commonly reported adverse effect, but hemodynamic instabi lity with hypotension and even myocardial infarction have been reporte d, The cause of these adverse events has not been defined clearly, but may be secondary to the infusion of cytokines, The present study show ed the presence and significant elevation of the cytokine levels in th e wound drainage blood, A comprehensive review of the literature revea led that unwashed drainage blood is a relatively dilute blood product lacking normal clotting factors and having numerous other undesirable components that may mitigate against its routine use in lieu of predep osited autologous or homologous blood, This is of interest because the re is evidence indicating that wound drainage blood reinfusion may be unnecessary in total joint arthroplasty when autologous blood is avail able, Use of drains in this surgery also may be unnecessary and has be en shown to increase the amount of blood toss and the need for transfu sion.