A trial of fresh autologous whole blood to treat dilutional coagulopathy following cardiopulmonary bypass in infants

• Published in: Pediatric anesthesia Vol. 16; no. 4; pp. 429 - 435
• Main Authors: FRIESEN, ROBERT H., PERRYMAN, KATHY M., WEIGERS, KIM R., MITCHELL, MAX B., FRIESEN, RICHARD M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2006; Blackwell
• Subjects: acute normovolemic hemodilution; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - therapeutic use; Biological and medical sciences; Blood Coagulation Disorders - therapy; Blood Transfusion, Autologous - adverse effects; cardiac: cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; dilutional coagulopathy; Female; Fibrinogen - analysis; Fibrinogen - metabolism; Hemodilution - adverse effects; Heparin - therapeutic use; Humans; Infant; Male; Medical sciences; Platelet Count; Postoperative Complications - therapy; Prothrombin Time; Treatment Outcome; Human; Cardiopulmonary bypass; dilutional coagulopathy; Anesthesia; Hemodilution; Infant; Hemopathy; Autologous system; acute normovolemic hemodilution; Coagulopathy; cardiac
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2005.01805.x

Summary Background:  Transfusion of fresh whole blood is superior to blood component therapy in correcting coagulopathies in children following cardiopulmonary bypass (CPB); however, a supply of fresh homologous whole blood is difficult to maintain. We hypothesized that transfusion of fresh autologous whole blood obtained prior to heparinization for CPB and infused following CPB would be associated with improved coagulation function when compared with standard therapy. Methods:  A total of 32 infants 5–12 kg undergoing noncomplex open cardiac surgery were randomly assigned to either the treatment or control group. In the treatment group, 15 ml·kg−1 of autologous whole blood was collected into a CPDA bag prior to heparinization while 15 ml·kg−1 of 5% albumin was infused intravenously. After reversal of heparin, coagulation tests were drawn in both groups, and the autologous whole blood was infused over 20 min in the treatment group. Results:  The treatment group had greater (P < 0.05) improvement in platelet count, prothrombin time, and fibrinogen than the control group. Conclusions:  We conclude that collection of fresh autologous whole blood prior to heparinization and reinfusion following CPB is associated with greater improvement of coagulation status after CPB in infants.