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CARDIOVASCULAR ANESTHESIA

Are Leukocytes in Salvaged Washed Autologous Blood Harmful for the Recipient? The Results of a Pilot Study

Petra Innerhofer, MD^*, Franz J. Wiedermann, MD^*, Werner Tiefenthaler, MD^*, Wolfgang Schobersberger, MD^*, Anton Klingler, PhD, Corinna Velik-Salchner, MD^*, Elgar Oswald, MD^*, Erwin Salner, MD^*, Eveline Irschick, PhD, and Gabriele Kühbacher, MD^*

*Department of Anesthesia and Critical Care Medicine, Theoretical Surgery Unit, Department of General Surgery, and Department of Ophthalmology, Immunological Laboratory, The Leopold-Franzens University of Innsbruck, Innsbruck, Austria

Address correspondence and reprint requests to Petra Innerhofer, MD, Department of Anesthesia and Critical Care Medicine, The Leopold-Franzens University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria. Address e-mail to Petra.Innerhofer{at}uibk.ac.at

To explore whether polymorphonuclear leukocytes (PMNL) are activated to the priming threshold through intraoperative blood salvage, and are thus able to induce endothelial damage, we investigated chemotactic response (n = 20) and respiratory burst (RB; n = 20) of PMNL without (basal respiratory burst, bPMNL-RB) and after in vitro stimulation with formyl-Met-Leu-Phe (fMLP-RB) and phorbol myristate acetate (PMA-RB). Blood was processed with a continuous autotransfusion device (CATS). Heparin (Heparin group) and sodium citrate (Citrate group) were used alternately as an anticoagulant for each half of the chemotaxis and RB studies. Comparison of measurements from the processed autologous erythrocyte concentrates (paEC) to pre- and intraoperative arterial blood samples showed no statistically significant difference for any test of PMNL functional responses in an orthopedic patient population. Analysis of intraindividual changes demonstrated a significantly increased bPMNL-RB (both groups, P = 0.0032; Heparin group, P = 0.0098), fMLP-RB (both groups, P = 0.0484; Citrate group, P = 0.0371), and PMA-RB (Citrate group, P = 0.002) in the paEC compared with intraoperative arterial samples, whereas the chemotactic response did not change. Nevertheless, median values of all RB measurements in the paEC were within the range of pre- and intraoperative values, indicating that PMNLs contained in the paEC are neither impaired nor activated to the priming threshold. The results confirm the clinical experience that intraoperative blood salvage is safe to use during major orthopedic surgery and questions the beneficial effect of special leukocyte-removing filters.

IMPLICATIONS:Leukocytes contained in intraoperatively processed autologous blood using either heparin or citrate were not activated to the threshold that is associated with leukocyte-mediated tissue injury. This study raises the question of the necessity of special leukocyte filters for the transfusion of intraoperatively salvaged blood.

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