Oxygen carrying capacity of salvaged blood in patients undergoing off-pump coronary artery bypass grafting surgery : a prospective observational study

BACKGROUND: Intraoperative cell salvage (ICS), hereby referred to ‘mechanical red cell salvage’, has been widely used and proven to be an effective way to reduce or avoid the need for allogeneic red blood cells (RBCs)transfusion and its associated complications in surgeries involving major blood loss. However, little is known about the influence of this technique on the functional state of salvaged RBCs. Furthermore, there are no articles that describe the change of free hemoglobin (fHb) in salvage blood during storage, which is a key index of the quality control of salvaged blood. Therefore, in this study, the influence of ICS on the function of salvaged RBCs and the changes of salvaged RBCs during storage were studied with respect to the presence of oxyhemoglobin affinity (recorded as a P(50) value) and the level of 2, 3-diphosphoglycerate (2, 3-DPG) and fHb by comparing salvaged RBCs with self-venous RBCs and 2-week-old packed RBCs. METHODS: Fifteen patients undergoing off-pump coronary artery bypass grafting (OPCAB) surgery were enrolled. Blood was collected and processed using a Dideco Electa device. The level of P(50), 2, 3-DPG and fHB from salvaged RBCs, venous RBCs and 2-week-old packed RBCs was measured. We also measured the changes of these indicators among salvaged RBCs at 4 h (storage at 21–24 °C) and at 24 h (storage at 1–6 °C). RESULTS: The P(50) value of salvaged RBCs at 0 h (28.77 ± 0.27 mmHg) was significantly higher than the value of venous RBCs (27.07 ± 0.23 mmHg, p = 0.000) and the value of the 2-week-old packed RBCs (16.26 ± 0.62 mmHg, p = 0.000). P(50) value did not change obviously at 4 h (p = 0.121) and 24 h (p = 0.384) compared with the value at 0 h. The 2, 3-DPG value of salvaged RBCs at 0 h (17.94 ± 6.91 μmol/g Hb) was significantly higher than the value of venous RBCs (12.73 ± 6.52 mmHg, p = 0.007) and the value of the 2-week-old packed RBCs (2.62 ± 3.13 mmHg, p = 0.000). The level of 2, 3-DPG slightly decreased at 4 h (p = 0.380) and 24 h (p = 0.425) compared with the value at 0 h. Percentage of hemolysis of the salvaged blood at 0 h(0.51 ± 0.27 %) was significantly higher than the level of venous blood (0.07 ± 0.05 %, p = 0.000) and the value of 2-week-old packed RBCs (0.07 ± 0.05 %, p = 0.000), and reached 1.11 ± 0.42 % at 4 h (p = 0.002) and 1.83 ± 0.77 % at 24 h (p = 0.000). CONCLUSIONS: The oxygen transport function of salvaged RBCs at 0 h was not influenced by the cell salvage process and was better than that of the venous RBCs and 2-week-old packed RBCs. At the end of storage, the oxygen transport function of salvaged RBCs did not change obviously, but percentage of hemolysis significantly increased

Red Cell 2,3‐Diphosphoglycerate Levels in Children with Hereditary Haemolytic Anaemias

The role of red cell 2,3‐diphosphoglycerate (2,3‐DPG) in increasing the availability of haemoglobin oxygen in neonatal jaundice and hereditary haemolytic anaemias was investigated. Measurements of 2,3‐DPG were carried out on 58 normal children and six normal adults, 18 full‐term newborns with neonatal jaundice and 57 cases (51 children and six adults) with hereditary haemolytic anaemias. In normal children and adults, with a mean haemoglobin of 12.69 g/dl, mean 2,3‐DPG was 14.90 μmol/g Hb. In jaundiced newborns with a mean haemoglobin of 16.04 g/dl mean 2,3‐DPG levels were 14.51 μmol/g Hb, i.e. normal. 2,3‐DPG levels were increased in patients with β‐thalassaemia major, α‐thalassaemia, sickle‐cell disease, favism, hereditary spherocytosis and in heterozygotes for β‐thalassaemia with increased haemoglobin F. In heterozygotes for β‐thalassaemia with increased haemoglobin A2 only and in sickle cell trait 2,3‐DPG levels were normal. Copyright © 1975, Wiley Blackwell. All rights reserve

Growth of children with thalassaemia: Effect of different transfusion regimens

Growth was studied in 74 children with homozygous β-thalassaemia aged 1 to 11 years, treated with three different transfusion regimens. In group I (38 cases) haemoglobin levels were maintained above 8 g./100 ml.; in group II (14 cases), pretransfusion haemoglobin levels ranged between 6 and 8 g./100 ml.; in group III (22 children), pretransfusion haemoglobin levels were below 6 g./100 ml. Children in group I grew normally, both in weight and height; those in groups II and III were retarded, particularly those in group III. Frequent transfusions, in spite of their disadvantages, at present constitute the treatment of choice

17 YEARS OF EXPERIENCE WITH CHRONIC IDIOPATHIC THROMBOCYTOPENIC PURPURA IN CHILDHOOD - IS THERAPY ALWAYS BETTER

Between 1975 and 1992 450 children with idiopathic thrombocytopenic purpura (ITP) were diagnosed, and of those 100 (22%) developed the chronic form of the disease. Approximately half the patients with chronic ITP presented with mild to moderate hemorrhagic manifestations at the onset of purpura (30 cases) and/or later during the course of the disease (25 cases). The incidence of intracranial hemorrhage was 1%, and the mortality rate due to overwhelming septicemia after splenectomy was also 1%. Overall one-third of the patients received no therapy; two-thirds of them went into spontaneous remission within 8 months to 8 years from the onset of ITP. Steroids given in conventional or high doses (51 cases) achieved a transient (if any) rise in platelet count, but in no case were steriods curative. Remission related to intravenous immune globulin (IVIG) therapy was noticed in 38.5% of the children (10 of 26) after variable courses. The response rate to splenectomy was 95.0%. Ultimately the long-term outcome in children with chronic ITP was as follows: remission, 58 cases (spontaneous, 30; after IVIG therapy, 10; after splenectomy, 18); hemostatic platelet values, 22 cases (spontaneous, 16; after IVIG, 5; after splenectomy, 1). Thirteen children were lost in follow-up, and 7 remain thrombocytopenic but asymptomatic. These data indicate that chronic ITP in childhood runs a benign course in most cases and may remit with or without therapy even several years from onset. Therefore, therapeutic intervention has to be individualized, and splenectomy, which is not always safe, should be reserved for problematic cases that fail to respond to conventional therapeutic modalities

Increased urinary catecholamines in an infant with the diencephalic syndrome

In an infant of 15 months with the diencephalic syndrome, urinary excretion of norepinephrine was moderately raised and epinephrine greatly so. It is suggested that catecholamine secretion may be due to sympathetic stimulation at the level of the diencephalon, by a space-occupying lesion pressing on the thalamohypothalamic pathway. Some of the symptoms of the diencephalic syndrome such as euphoria, irritability, skin pallor, and hypertension may be the result of catecholamine secretion