Retransfusion system with integrated double filtration – parameters of product quality

Czech version

Authors: Š. Maříková ¹; L. Řehořová ^1,5; R. Mizera ²; L. Walterová ³; I. Ouhrabková ⁴; R. Procházková ^1,5
Published in: Transfuze Hematol. dnes,20, 2014, No. 4, p. 117-124.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Introduction.
Retransfusion systems enable the collection of blood from the surgical field via drains, channelling it back to the patients’ vein. The aim of the study was to determine the qualitative and quantitative changes in biological parameters of blood collected through a retransfusion system and evaluation of patient safety.

Materials and Methods.
We measured quality parameters, markers of red cell storage lesion and coagulation tests in retransfusion products. Quality parameters and markers of cell lesion were compared with standard red blood components (RBCs). We used the Shapiro-Wilk test, nonparametric Mann-Whitney test and parametric two-tailed t-test for statistical evaluation. Statistical significance was assessed at the level of p < 0.05.

Results.
Values of haemoglobin and haematocrit were significantly lower when compared with RBCs (Hb 93 ± 24 g/l vs. 197 ± 10 g/l; Ht 0.28 ± 0.07 vs. 0.59 ± 0.03, p < 0.001). Retransfusion products showed a significantly higher content of leukocytes (11.9 ± 4.0 × 10⁹/l vs. 2.2 ± 1.3 × 10⁹/l; p < 0.001) and a higher level of plasma haemoglobin (0.42% ± 0.14% vs. 0.34% ± 0.17%, p < 0.05) when compared with standard RBCs. The level of potassium, LDH and lactate in retransfusion products was significantly higher than in RBCs at the beginning of storage (p < 0.001), but significantly lower than in RBCs at the end of storage. Retransfusion products showed significantly lower values of pH compared with RBCs at the beginning of storage (p < 0.001) and significantly higher pH when compared with RBCs at the end of storage (p < 0.001). The value of triglycerides in the product was higher (2.21 ± 0.85 mmol/l). The values of PT, APTT, TT and fibrinogen were not measurable. The level of D-dimers was significantly higher (> 10 mg/l FEU) and AT III levels lower (42.6 ± 7.4%). Bacterial contamination was not found in any of the tested products.

Conclusion.
Compared to RBCs, the retransfusion product has approximately half of the haemoglobin content, so it is not entirely equivalent to standard red cell concentrates. The amount of haemolysis in the retransfusion product meets the quality parameters of standard RBCs. Increased levels of potassium and LDH are related to the destruction of red blood cells. Coagulation parameter results are irrelevant as to the consumption of coagulation proteins during preparation of the final product. The thrombogenicity of retransfusion products is not entirely clear and deserves further research. It appears that the retransfusion product is relatively safe for patients based on the results of this research.

Key words:
retransfusion, retransfusion system, red cells buffy coat removed, in additive solution, red cells, apheresis

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