AUTOTRANSFUSION OF SHED BLOOD CONTRIBUTES ADDITIONALLY TO BLOOD SAVING IN PATIENTS RECEIVING APROTININ (2 MILLION KIU)

Aprotinin decreases the hemoglobin content of shed blood significantly and thereby could potentially reduce the contribution of autotransfus ion of shed blood to the blood-saving program. In part 1, by means of a prospective randomized study, we evaluated the effect of autotransfu sion (AT) of shed blood on the reduction and avoidance of donor blood requirements in 40 matched patients undergoing internal mammary artery bypass (IMA) surgery and treatment with low-dose aprotinin (2 million KIU). Twenty patients (Group 1) received AT with a hard shell cardiot omy reservoir; twenty patients (Group 2, control) did not receive AT. In part 2, we studied at random the hemoglobin and total-protein conte nt of shed blood in 10 patients of group 2 and in 10 IMA patients not receiving aprotinin. Retransfused patients required 0.1 +/- 0.3 units of donor blood versus 0.8 +/- 0.2 units in non-retransfused patients ( not significant). The use of any blood product was avoided in 95% and 80% of the patients, respectively (not significant). Patients receivin g aprotinin lost 50% less (P < 0.05) hemoglobin (62 g) and total-prote in (28 g) in their drainage system than patients not receiving aprotin in. It was calculated that autotransfusion of about 530 ml of shed blo od in aprotinin-treated patients, is equivalent to 0.4 units of homolo gous packed cells. In conclusion, autotransfusion of shed blood may co ntribute to blood saving in IMA patients treated with aprotinin, which reduces the shed blood hemoglobin and total protein content by 50%.