Quantitative and qualitative evaluation of blood salvaged after extracorporeal circulation (ECC) in paediatric heart surgery - Study of biochemical, morphological and structural variations of RBC after ECC and after salvaging of ECC circuit priming blood

The salvaging of ECC circuit priming blood is essential for reducing the mo rbidity related to homologous blood transfusions and the importance of this technique is inversely proportionate to the age and weight of the child. I n infants, the washing and centrifugation of blood not only drastically red uce the risk of contracting blood-transmitted diseases and cut management c osts, but are also of considerable hemodynamic importance, producing a rapi d normalization of the patient's hematocrit and hemoglobin and balancing th e O-2 consumption/demand ratio. The marketing of miniaturized salvaging dev ices with 55 mi bowls by Dideco has made possible the recovery of small qua ntifies of blood, so as to normalise the hematic crisis and permit the appl ication of total hemodilution in low-weight patients. The salvaged blood sh ows an average hematocrit of 52.7+/-9.7% (max 68.1%) and an average hemoglo bin of 17.6+/-2.9 g/dl (max 20.7 g/dl), and maintains ifs structural compon ents, osmotic resistance, concentration of intraerythrocytic hemoglobin and mean corpuscular hemoglobin all intact. Washing with isoosmotic and isoionic hydroelectrolytic solutions normalizes the ionic situation in the post-operative period and activated blood salva ging after Extracorporeal Circulation. The use of solutions without nutriti onal substances results however in a considerable fall in the number of enz ymes in the intraerythrocytic metabolic glucide chain (G(6)PDH: -40.7+/-14. 3% p<0.001), (PK: -23.8+/-20.5% p<0.03). This drop may be responsible for e rythrocytic morphological alterations (echinocytic change) and probably for the release of hemoglobin from the red blood cells. Washing with isoionic, isoosmotic solutions containing G5% and adenine coul d, at least in theory improve the qualify of the salvaged blood, by normali zing the morphology and the volume of the RBC and by increasing the hematoc rit.