Safety and efficacy of preoperative autologous apheresis platelet donation in coronary artery bypass grafting patients

• Published in: Indian journal of thoracic and cardiovascular surgery Vol. 28; no. 3; pp. 160 - 164
• Main Authors: Sharma, Vikas, Kumar ST, Shyam, Sharma, Ratti Ram, Marwaha, Neelam, Hans, Rekha
• Format: Journal Article
• Language: English
• Published: India Springer-Verlag 01.09.2012
• Subjects: Cardiac Surgery; Medicine; Medicine & Public Health; Original Article; Surgery; Thoracic Surgery; Vascular Surgery; Autologous; Coronary artery bypass grafting; Homologous apheresis platelet concentrate
• ISSN: 0970-9134; 0973-7723
• DOI: 10.1007/s12055-012-0157-1

Background Demand for platelets is a concern for Coronary Artery Bypass Grafting (CABG) patients. Transfusion of platelet concentrates, in form of apheresis platelets or random donor platelets are used to achieve hemostasis after Coronary Pulmonary Bypass (CPB) but also expose the recipient to the risks of transfusion reactions, allo-immunisation and transmission of infectious agents. This study was designed to compare the efficacy and safety of apheresis platelet concentrate (autologous and homologous) and Random Donor Platelets (RDP). Materials and methods This study was conducted in Department of Cardiovascular and Thoracic Surgery and Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh over 1 year. Thirty consecutive patients with coronary artery disease were recruited in the study and divided into three groups—group 1-autologous apheresis, group 2-random donor platelets, group 3-homologous apheresis platelets. Each group had 10 patients. Levels of platelet activation marker—human soluble-P-selectin was estimated in platelet products (apheresis and random donor platelets), in patient’s sample (pre and postoperatively) and posttransfusion at 1 h and 24 h. Results There was significantly lower 24 h blood loss postoperatively in patients receiving apheresis platelets as compared to random donor platelets ( p  < 0.05). There was decreased post operative transfusion requirements of both red cells and Fresh Frozen Plasma (FFP)/platelet concentrates in the apheresis group ( p  < 0.05) as compared to Random donor platelet group. Apheresis platelets had better quality control parameters than random donor platelets i.e., pH −7.0 Vs 6.5 and White Blood Cells (WBC) count −10 6 Vs 10 7 respectively. There was decreased in vitro/in vivo activation of platelets as evidenced by lower P-selectin levels in samples from platelet units and patients. None of the patient had any serious adverse reaction during or after the autologous apheresis donation. Conclusions Harvesting of platelets by apheresis preoperatively before CPB is one of the good means of providing safe and good quality platelets in adequate dose.