Platelet-rich plasma sequestration, with therapeutic platelet yields, reduces allogeneic transfusion in complex cardiac surgery

Platelet dysfunction is the most common cause of nonsurgical bleeding after cardiopulmonary bypass (CPB). We hypothesized that reinfusion of a therape utic quantity of platelets sequestered before CPB would decrease the need f or allogeneic platelet transfusion, as well as decrease bleeding and total allogeneic transfusion, in cardiac surgery patients at moderately high risk for bleeding. Fifty-five patients undergoing either reoperative coronary a rtery bypass (CABG) or combined CABG and valve replacement were randomized to control or platelet-rich plasma sequestration (pheresis) groups. All pat ients received intraoperative epsilon-aminocaproic acid infusions. There wa s no significant difference between groups with respect to preoperative cha racteristics, duration of CPB, or target postoperative hematocrit. Mean pla telet yields were 6.2 +/- 2.1 units (3.1 X 10(11) platelets). Mean pheresis time was 44 min. Allogeneic platelets (range = 6-12 units) were transfused to 28% of control patients, compared with 0% of pheresis patients (P < 0.0 1). Allogeneic packed red blood cells were transfused to 45% of control pat ients (1.2 units per patient) versus 31% of pheresis patients (0.7 unit per patient) (P = 0.35). Total allogeneic units transfused were significantly reduced in the pheresis group (P < 0.02). Mediastinal chest tube drainage w as not significantly decreased in the pheresis group. In this prospective, randomized study, therapeutic platelet yields were obtained before CPB. in contrast with recent studies with low platelet yields, these data support t he conclusion that platelet-rich plasma sequestration is effective in reduc ing allogeneic platelet transfusions and total allogeneic units transfused in cardiac surgery patients at moderately high risk for post-CPB coagulopat hy and bleeding. Implications: Transfusion of allogeneic blood products, in cluding platelets, is common during complex cardiac surgical procedures. In the present prospective, randomized study, a significant reduction in allo geneic platelet transfusion and total allogeneic units transfused was obser ved after the reinfusion of a therapeutic quantity of autologous platelets sequestered before cardiopulmonary bypass.