Platelet function during platelet-rich plasma squestration in complex cardiac surgery

 

Introduction Platelets are the most fragile components of hemostasis in cardiac surgery with cardiopulmonary bypass (CPB).

Contemporary cell-salvage technology can preserve not only red blood cells (RBC) but also platelets in platelet-rich plasma (PRP) sequestration during complex surgical procedures. We tested the presevation of platelet functions during and after PRP sequestration.

Method We obtained informed consent and local ethic commitee approval. In 15 elective adult patients (13 male, 2 female, average age 68 years) scheduled for complex cardiac surgery surgery (aortic, combined and redo, with average CPB time 135 min, cross-clamp time 96 min) with preoperative haematocrit>0,35 we performed RBC and PRP sequestration (800 ml preoperative autologous blood was processed). Standard mild hypotermic CPB with centrifugal pump, biocompatible surface – X- coating, heparin dose 3mg/kg and protamin reversal 1:1 was used. All the patients were treated with tranexamic acid 30mg/kg i.v. before surgery and 15mg/kg into the CPB priming volume.The Sorin X.tra®​ cell-saver (175 ml Latham bowl, 2 port system, CPDA bags, prime flow 100 ml/min, PRP spill volume 60 ml/min, spill flow 20 ml/min) was used. PRP was re-transfused immediately after the end of CPB, RBC according to the hemoglobin level at the end of surgery or in ICU. Platelet count and optical aggregometry (aggregation induced by ristocetin, epinephrin, ADP and collagen) before procedure, in processed plasma, at the end of surgery and after PRP retransfusion were assessed. Thromoelastographic parametres (TEG 5000) were assessed before and after CPB. Transfusion therapy was provided by the TEG – guided algorithm.

Results The average amount of autologous blood processed was 874±76ml, the average re-transfused PRP volume 538±57 ml. The average blood loss during the 24 hour period was 676±281 ml. Reexploration due to haemorrhage occurred in 3 patients. Transfusion with FFP was required in 5 cases (range 2 to 6 units), and with RBC in 4 cases (range 2 to 6 units). No platelet transfusions were required. PCC was used in 3 patients, fibrinogen in 1 case. TEG parameters did not differ between the groups. The mean (SD) platelet count before surgery was 187 (35), in PRP 113 (36), after PRP transfusion 126 (31), and after surgery 122 (35) x 109/L. There were statistically significant decreases of collagen-, ADP- and epinephrine-mediated, but not ristocetin-mediated aggregation (97% of baseline) in PRP compared with the pre-CPB sample. The partial restoration of aggregation after PRP retransfusion was assessed.(median reactivity: collagen 33 to 29%, ADP 68 to 73%, ristocetin 97 to 87%,and epinephrine 19 to 18% of baseline) [1] [2] ([Fig. 1], [Fig. 2]).

Conclusion PRP sequetrastion is a safe method. It preserved platelet count and ristocetin-mediated pletelet aggregation, and partially restored other activator- mediated aggregation after CPB.

Publication History

Article published online:
26 February 2024

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