Fresh Autologous Whole Blood Transfusion After Cardiopulmonary Bypass

Summary

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Description

Cardiac surgery carries a significant risk of bleeding requiring transfusion of stored blood products and blood transfusion associated with cardiac surgery consumes 20% of the blood supply worldwide. Although transfusion may be life-saving, significant risks of complications such as lung injury or e...

Cardiac surgery carries a significant risk of bleeding requiring transfusion of stored blood products and blood transfusion associated with cardiac surgery consumes 20% of the blood supply worldwide. Although transfusion may be life-saving, significant risks of complications such as lung injury or even an increase in mortality are associated with transfusion. Decreasing transfusion requirements during cardiac surgery has the potential to reduce the rate of complications, improve patient outcomes, and reduce cost resulting in increased value for both the patient and the health system as a whole. Collection of autologous blood before cardiopulmonary bypass (CPB) for transfusion after CPB has been shown to be both safe and effective for reducing blood loss during cardiac surgery, but this intervention has not been targeted to a patient population at high risk for bleeding and transfusion. Fresh whole blood has the capacity to restore coagulation system function during profound coagulopathy in a trauma setting or following massive transfusion by an unknown mechanism. One unit of fresh whole blood is able to restore clotting function equivalent to that achieved by 10 units of pooled platelets. Autologous whole blood collection prior to CPB for transfusion post-operatively has been shown to improve coagulation and decrease clot lysis but is not routinely performed because 90% to 95% of patients do not have extensive blood loss and subsequent coagulopathy. Coupling accurate pre-operative bleeding risk prediction with autologous fresh whole blood collection for transfusion after CPB would target an established, low cost, low risk intervention to an at risk patient population who may experience significant benefit. Red blood cell transfusion is performed to correct insufficient oxygen carrying capacity or oxygen delivery, but no robust measure of tissue oxygen delivery is currently available. Specific aim 2 will address this gap in knowledge by performing absolute quantification of citric acid cycle intermediates using mass spectrometry that are markers of mitochondrial respiration. Of particular interest, increased plasma levels of succinate have been shown to be associated with trauma associated mortality and the accumulation of succinate is likely due to reversal of flow of the succinate dehydrogenase complex in the absence of oxygen (unpublished data). Measurement of these markers before and after transfusion will determine the resuscitative capacity of allogenic packed red blood cells compared to fresh autologous whole blood.

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