SAFETY AND THERAPEUTIC EFFECTIVENESS OF REINFUSED SHED BLOOD AFTER OPEN-HEART-SURGERY

This prospective study was designed to determine whether use of nonwas hed shed mediastinal blood exacerbated platelet and related hematologi c dysfunctions after cardiopulmonary bypass, compared with the alterna tive use of autologous and homologous standard liquid preserved blood fbr volume support. Thirty-two patients undergoing cardiopulmonary byp ass for open heart operations were randomized to receive either nonwas hed shed mediastinal blood (group 1; n = 16) or liquid preserved packe d red blood cells (group 2; n = 16) for transfusion therapy in the man agement of postoperative bleeding. Patient blood samples and bleeding times were obtained preoperatively, after cardiopulmonary bypass but b efore transfusions, 2 and 24 hours after transfusion, and on postopera tive days 2, 3, and 7. Group 1 patients received an average of 710 +/- 90 mL (range, 300 to 1,700 mL) of nonwashed shed mediastinal blood co ntaining significantly greater (p < 0.0001) amounts of fibrin degradat ion products and D-dimer protein. Of the hematologic, microaggregate, and plasma protein measurements performed, only the protein C level wa s significantly greater in group 1 (p < 0.05) after transfusion. Patie nt bleeding times were not significantly different between the groups at any of the time points, and the total postoperative blood loss was not different between the groups. There was a trend toward less need f or homologous transfusion in group 1 (p < 0.1). This study documents t he safety and ease of using nonwashed shed mediastinal blood as a prim ary blood volume support after an open heart operation.