Platelet Function in Stored Heparinised Autologous Blood Is Not Superior to in Patient Platelet Function during Routine Cardiopulmonary Bypass

Rolf C G Gallandat Huet,Ton Lisman,Vladimir Cernak,Adrianus J De Vries,Mercedes Susan Mandell

doi:10.1371/journal.pone.0033686

Rolf C G Gallandat Huet, Ton Lisman + Show 3 more

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https://doi.org/10.1371/journal.pone.0033686

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Abstract

BackgroundIn cardiac surgery, cardiopulmonary bypass (CPB) and unfractionated heparin have negative effects on blood platelet function. In acute normovolemic haemodilution autologous unfractionated heparinised blood is stored ex-vivo and retransfused at the end of the procedure to reduce (allogeneic) transfusion requirements. In this observational study we assessed whether platelet function is better preserved in ex vivo stored autologous blood compared to platelet function in the patient during CPB.Methodology/Principal FindingWe measured platelet aggregation responses pre-CPB, 5 min after the start of CPB, at the end of CPB, and after unfractionated heparin reversal, using multiple electrode aggregometry (Multiplate®) with adenosine diphosphate (ADP), thrombin receptor activating peptide (TRAP) and ristocetin activated test cells. We compared blood samples taken from the patient with samples taken from 100 ml ex-vivo stored blood, which we took to mimick blood storage during normovolemic haemodilution. Platelet function declined both in ex-vivo stored blood as well as in blood taken from the patient. At the end of CPB there were no differences in platelet aggregation responses between samples from the ex vivo stored blood and the patient.Conclusion/SignificanceEx vivo preservation of autologous blood in unfractionated heparin does not seem to be profitable to preserve platelet function.

Highlights

Cardiac surgery is associated with blood platelet dysfunction and perioperative coagulation disturbances [1,2]
In samples taken after cardiopulmonary bypass (CPB), adenosine diphosphate (ADP)- and ristocetin-induced aggregation were lower compared to pre-CPB levels
At the end of CPB there was no difference in the platelet aggregation response with all activators between the samples from the ex-vivo stored autologous blood and samples taken from the patient. In this observational study we found no difference in the platelet aggregation induced by ADP, thrombin receptor activating peptide (TRAP), or ristocetin between samples taken from cardiac surgical patients at the end of CPB and ex-vivo stored heparinised autologous blood

Summary

Introduction

Cardiac surgery is associated with blood platelet dysfunction and perioperative coagulation disturbances [1,2]. During cardiac surgery several techniques are advocated to preserve coagulation factors and platelet function, in order to reduce allogeneic transfusion. These techniques include intra-operative platelet anesthesia [6,7], platelet-rich plasma harvesting [8] and acute normovolemic haemodilution (ANH) with sequestration of unfractionated heparinised autologous blood [9,10]. In acute normovolemic haemodilution autologous unfractionated heparinised blood is stored ex-vivo and retransfused at the end of the procedure to reduce (allogeneic) transfusion requirements

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