Fibrinolytic activity and postoperative salvaged untreated blood for autologous transfusion in major orthopaedic surgery

Abstract

Objective: To evaluate the fibrinolytic activity in a closed surgical wound, in postoperatively drained blood, and during autologous transfusion. Design: Prospective study. Setting: National hospital, Norway. Patients: 9 patients operated on for thoracic scoliosis. Main outcome measure: Concentrations of plasmin/antiplasmin (PAP), α2-antiplasmin, and D-dimers in drained, arterial, and mixed venous blood before, during, and after infusion of 10 ml/kg body weight of postoperatively drained, untreated blood. Results: In drained blood the concentration of α2-antiplasmin was 31% of the preoperative arterial control value. Together with the increased concentrations of PAP to 18076 μg/L and D-dimers to 126 mg/L, this indicates extensive fibrinolytic activity in the closed wound. The postoperative autologous transfusion of drained, untreated blood increased the concentration of PAP from 507 to 2453 μg/L and of D-dimer from 0.7 mg/L to 15.3 mg/L in systemic blood. Conclusion: The systemic concentration of fibrin(ogen) degradation products, indicated by D-dimers, after recirculation of drained, untreated blood might impair coagulation. The extensive activation of plasmin might exhaust available α2-antiplasmin in the wound and result in postoperative rebleeding.