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

Abstract

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 P50 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 P50, 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 4h (storage at 21-24 °C) and at 24h (storage at 1-6°C). Results: The P50 value of salvaged RBCs at 0h (28.77±0.27mmHg) was significantly higher than the value of venous RBCs (27.07±0.23mmHg, p=0.000) and the value of the 2-week-old packed RBCs (16.26±0.62mmHg, p=0.000). P50 value did not change obviously at 4h (p=0.121) and 24h (p=0.384) compared with the value at 0h. The 2, 3-DPG value of salvaged RBCs at 0h (17.94±6.91μmol/g Hb) was significantly higher than the value of venous RBCs (12.73±6.52mmHg, p=0.007) and the value of the 2-week-old packed RBCs (2.62±3.13mmHg, p=0.000). The level of 2, 3-DPG slightly decreased at 4h (p=0.380) and 24h (p=0.425) compared with the value at 0h. Percentage of hemolysis of the salvaged blood at 0h(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 4h (p=0.002) and 1.83±0.77% at 24h (p=0.000). Conclusions: The oxygen transport function of salvaged RBCs at 0h 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.