Autotransfusion after open heart surgery: characteristics of shed mediastinal blood and its influence on the plasma proteases in circulating blood

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Abstract
Fourteen patients undergoing open‐heart surgery received intermittent or continuous postoperative autotransfusion of shed mediastinal blood (minimum 400 ml during 6 h after surgery) collected in the cardiotomy reservoir. Haemotologic variables and changes in the coagulation, fibrinolytic and plasma kallikrein‐kinin systems were investigated in the reservoir blood at the beginning and after 6 h of autotransfusion, and in patient blood during and after surgery and before and after autotransfusion. Autotransfusion volume ranged from 400 to 1200 ml per patient (median 482 ml). The reservoir blood had a median haemoglobin level of 93 and 74 g/1, a platelet count of 71 and 119times 109/1, and plasma haemoglobin level of 3110 and 4100 mg/1 before and after 6 h of autotransfusion, respectively: Further examination of the reservoir blood showed that it had undergone extensive coagulation and fibrinolysis as well as a moderate activation of the kallikrein‐kinin system. Despite these extensive alterations in the reservoir blood, no major change could be found in the circulating blood after autotransfusion, except for a moderate increase in plasma haemoglobin from 180 mg/1 to 430 mg/1. The clinical safety and simplicity of this technique were confirmed for autotransfusion of shed mediastinal blood up to 1200 ml.