Korrin J Scott1, J William Shteamer2, Fania Szlam3, Roman M Sniecinski4. 1. Emory University School of Medicine, Department of Anesthesiology, United States of America. Electronic address: korrin.scott@emory.edu. 2. Emory University School of Medicine, Department of Anesthesiology, United States of America. Electronic address: jack.williams.shteamer@emory.edu. 3. Emory University School of Medicine, United States of America. Electronic address: fszlam@emory.edu. 4. Emory University School of Medicine, Department of Anesthesiology, United States of America. Electronic address: roman.sniecinski@emory.edu.
Abstract
STUDY OBJECTIVE: We investigated the coagulation changes that might occur in acute normovolemic hemodilution (ANH) blood over several hours during cardiac surgery requiring cardiopulmonary bypass. DESIGN: This study was a prospective observational study. SETTING: This study took place at a university teaching hospital. PATIENTS: This study included 26 patients, either ASA 3 or 4 and without known coagulation disorders, undergoing cardiac surgery. Patients were included if the use of cardiopulmonary bypass was expected to reach 2.5 h. INTERVENTIONS: ANH blood was collected into CPDA-1 collection bags before systemic heparinization. Samples were taken directly from the bags at time of collection and reinfusion to assess changes in platelet and thrombin generation parameters. MEASUREMENTS: Whole blood from citrated tubes was used immediately for rotational thromboelastometry and platelet aggregometry analyses. Thrombin generation was assessed using calibrated automated thrombography with platelet poor plasma. MAIN RESULTS: Despite no significant change in platelet count over the ANH storage period, there was significant degradation in platelet function as measured by thrombin receptor activating peptide stimulation on Mulltiplate™ analysis and maximum clot formation on ROTEM™ EXTEM. Notably, there was no change in the ability to generate thrombin. CONCLUSIONS: Little data exists regarding the quality of coagulation factors in autologous blood. Our study confirms ANH collection results in decreased platelet aggregation with TRAP stimulation; however, this is not appreciated with ADP stimulation. Thrombin generation capacity remains preserved.
STUDY OBJECTIVE: We investigated the coagulation changes that might occur in acute normovolemic hemodilution (ANH) blood over several hours during cardiac surgery requiring cardiopulmonary bypass. DESIGN: This study was a prospective observational study. SETTING: This study took place at a university teaching hospital. PATIENTS: This study included 26 patients, either ASA 3 or 4 and without known coagulation disorders, undergoing cardiac surgery. Patients were included if the use of cardiopulmonary bypass was expected to reach 2.5 h. INTERVENTIONS: ANH blood was collected into CPDA-1 collection bags before systemic heparinization. Samples were taken directly from the bags at time of collection and reinfusion to assess changes in platelet and thrombin generation parameters. MEASUREMENTS: Whole blood from citrated tubes was used immediately for rotational thromboelastometry and platelet aggregometry analyses. Thrombin generation was assessed using calibrated automated thrombography with platelet poor plasma. MAIN RESULTS: Despite no significant change in platelet count over the ANH storage period, there was significant degradation in platelet function as measured by thrombin receptor activating peptide stimulation on Mulltiplate™ analysis and maximum clot formation on ROTEM™ EXTEM. Notably, there was no change in the ability to generate thrombin. CONCLUSIONS: Little data exists regarding the quality of coagulation factors in autologous blood. Our study confirms ANH collection results in decreased platelet aggregation with TRAP stimulation; however, this is not appreciated with ADP stimulation. Thrombin generation capacity remains preserved.