A cytokine analysis of the effect of cell saver on blood in coronary bypass surgery

Background: Increasing concern about the transmission of viral disease has generated greater interest in the use of salvaged blood as a means of allev iating the demand for homologous blood and expediting resuscitation during massive hemorrhage. Autologous blood processed by autotransfusion devices h as become increasingly common in major surgery and is now largely viewed as safe and efficacious. However, there may be serious complications and sequ elae associated with the use of processed blood, such as adult respiratory distress syndrome (ARDS) and renal failure. Complement cascade activation r esulting from blood coming into contact with autotransfusion equipment lead s to enrollment of leukocytes and release of large concentrations of cytoki nes, which may contribute to the development of organ failure. Our study ev aluated cytokine release during cell saver (CS) blood salvage in the course of coronary artery bypass grafting (CABG) surgery. Materials and Methods: Forty-five patients randomly selected for CABG were evaluated. All had received at least one unit of autotransfused blood by me ans of the Haemonetics Cell Saver(R) System 5 (Haemonetics Corp., Braintree , MA). Each patient had four blood samples taken (pre-operative, CS contain er, autotransfusion from the blood bag, and one hour post-transfusion). The se samples were then centrifuged and the sera were collected. An enzyme lin ked immunosorbent assay (ELISA) test, using the Biosource Cytoscreen solid phase "sandwich" ELISA kit (Biosource International, Camarillo, CA) was con ducted to determine levels of the cytokines Interleukin (IL) 1, 2, 4, 6, 8, and 10, tumor necrosis factor (TNF), intracellular adhesion molecule (ICAM ), and vascular cell adhesion molecule (VCAM). Results: Significantly increased concentrations of the pro-inflammatory cyt okines IL-1, 2, 4, 6, and 8, TNF, ICAM, and VCAM were noted throughout all time periods studied. The same effect was observed for the anti-inflammator y cytokine IL-10. Conclusion: Statistically significant increases in both the circulating lev els of the pro-inflammatory and antiinflammatory cytokines studied were rec orded. It is our contention that the presence of IL-10, a down-regulator of inflammation, is responsible for attenuating the possible deleterious effe cts of the pro-inflammatory cytokines observed. However, morbidity and mort ality, as well as the future patency of the bypass grafts, have not been co rrelated with the use of the autologous method of transfusion.