Jan Peter Bengtson

Postoperative Inflammatory Response after Autologous and Allogeneic Blood Transfusion

Background Allogeneic blood transfusions cause immunosuppression. The aim of this study was to determine whether complement anaphylatoxins, cytokines, or both are released in the recipient, after blood transfusions in general, and after autologous blood transfusions in particular. Methods Thirty-one patients having total hip joint replacement surgery were randomized to receive either allogeneic red blood cells (n = 15) or predeposited autologous whole blood transfusion (n = 16). Plasma concentrations of the anaphylatoxins C3a and C5a, the terminal C5b-9 complement complex, and cytokines IL-6 and IL-8 in the recipients were repeatedly analyzed before, during, and after surgery. Results Significantly increased concentrations of IL-6 and IL-8 appeared in both groups, with a significantly greater increase in the autologous blood group. Patients in both groups developed a moderate but significant increase of C3a without a significant difference between them. C5a and terminal C5b-9 complement complex were not greatly changed. Conclusions The study showed a greater increase in cytokine concentration after autologous blood transfusion than after allogeneic blood transfusion. The lower response in the latter may result from transfusion-induced suppression of cellular immunity.

Complement split products and pro-inflammatory cytokines in salvaged blood after hip and knee arthroplasty.

Purpose: To determine whether salvaged autologous blood collected postoperatively contains complement split products (SC5b-9), and pro-inflammatory cytokines (IL-6 and IL-8) and whether there are any differences between blood collected during hip or knee surgery.Methods: Fifty-eight consecutive patients undergoing hip or knee replacement surgery were studied. Thirty-eight had postoperative bleeding large enough to require infusion of salvaged blood. The salvaged blood was filtered during collection through a 200 µm filter and before infusion a 40 µm filter was used. Samples for complement and cytokine determinations were drawn from the circulation and from the collected blood.Results: High concentrations of SC5b-9, IL-6, and IL-8 were found in salvaged blood. The concentrations were higher than in the circulation (P<0.05). The circulating concentrations of IL-6 and IL-8 were increased 60 min and 12–18 hr after transfusion. There were no differences regarding SC5B-9, IL-6, and IL-8 in the blood collected after hip or knee surgery.Conclusion: Blood collected from a surgical wound contains large concentrations of inflammatory mediators. There were no differences between blood collected during hip or knee surgery.RésuméObjectif: Déterminer si la récupération postopératoire de sang autologue contient des produits de dégradation du complément (SC 5b-9) et des cytokines pro-inflammatoires (IL-6 et IL-8), et s’il y a des différences avec le sang prélevé pendant l’opération de la hanche ou du genou.Méthode: L’étude a porté sur 58 patients successivement admis pour la mise en place d’une prothèse de hanche ou du genou. Chez 38 d’entre eux, les pertes sanguines postopératoires ont été assez importantes pour nécessiter la transfusion de sang récupéré. Ce sang a été filtré pendant le prélèvement avec un filtre de 200 µm et avant la transfusion avec un filtre de 40 µm. Des échantillons retenus de la circulation et du sang récupéré ont servi à déterminer la cytokine et le complément.Résultats: De fortes concentrations de SC5B-9, IL-6 et IL-8 ont été trouvées dans le sang récupéré. Elles étaient plus élevées que celles de la circulation (P<0,05). Les concentrations circulantes de IL-6 et de IL-8 ont augmenté 60 min et 12–18 h après la transfusion. Aucune différence n’a été enregistrée concernant les SC5b-9, IL-6 et IL-8 dans le sang prélevé après l’opération de hanche ou du genou.Conclusion: Le sang prélevé au site d’incision chirurgicale contient de grandes concentrations de médiateurs de l’inflammation. Ce sang ne présente pas de différence avec celui qui est prélevé pendant une opération de hanche ou du genou.

Release of cytokines, polymorphonuclear elastase and terminal C5b-9 complement complex by infusion of wound drainage blood

25 patients undergoing total hip replacement surgery were studied in an investigation of release of cytokines (interleukin-1 beta, IL-1 beta; interleukin-6, IL-6; interleukin-8, IL-8; and tumor necrosis factor-alpha, TNF-alpha), PMN elastase and terminal C5b-9 complement complexes (TCC) at the time of collection and transfusion of autologous blood. 15 patients received wound blood that was washed and centrifuged before being transfused as an erythrocyte suspension. In this blood there were no elevations in the concentrations of cytokines, TNF-alpha, PMN elastase or TCC, and there was no increase in these variables in plasma after transfusion of wound blood. 10 patients received postoperatively-collected drainage blood. There were high amounts of cytokines, PMN elastase and TCC in this blood, and filtration of the collected drainage blood did not reduce the concentrations of these factors, except those of TCC. When the collected drainage blood was infused, elevated plasma concentrations of IL-6, IL-8 and PMN elastase were observed 1 and 60 minutes after completing the transfusion. No differences regarding blood pressure, oxygen saturation (SpO2), and hemoglobin concentration between the groups were recorded.

Autologous blood transfusion: Preoperative blood collection and blood salvage techniques

A VARIETY OF ALTERNATIVES to allogeneic blood transfusion have been proposed, such as use of solutions to support oxygen transport, human recombinant erythropoietin, and transfusion of autologous blood. The well recognised risks of transfusion of allogeneic blood have motivated physicians to search for less hazardous alternatives. At present autotransfusion is the most commonly used alternative to allogeneic blood transfusion. In order to minimise exposu-s to infectious agents, reduce cost, and reduce allogeneic transfusion requirements, the application of autotransfusion techniques has increased. Although beneficial to most patients, they are partieUlarly valuable to patients with rare blood types who have antibodies to common blood antigens. The feasibility of operating on Jehovahs Witnesses has also been dramatically improved with the use of intraoperative autotransfusion. Jehovahs Witnesses will not accept preoperative autologous blood collection or the use of a canister collection system if the blood is processed outside the operating room. However, most Jehovahs Witnesses will consent to Use autotransfusion if a continuous blood path is maintained throughout the period of scavenging and reinfusion.

Formation of complement split products and proinflammatory cytokines by reinfusion of shed autologous blood

1. The purpose of this study was to determine whether shed autologous blood collected postoperatively contains complement split products (C3a and SC5b-9) and proinflammatory cytokines (TNF-alpha, IL-1beta, IL-6 and IL-8) and whether transfusion of shed blood increases the concentrations of inflammatory mediators in the circulation. 2. Twenty consecutive patients undergoing total hip replacement surgery under spinal anaesthesia were studied. The patients were transfused with whole blood collected postoperatively. 3. The median volume shed blood returned to the patients was 350 ml (25-75% range = 300-450). Before transfusion of shed blood was filtered using a 40 microm filter (Solcotrans). Samples for complement and cytokine determinations were drawn from the collected blood. 4. Venous blood samples were drawn 1 min before transfusion, 1 and 60 min after completed transfusion. High concentrations of C3a, SC5b-9, TNF-alpha, IL-1beta, IL-6 and IL-8 were found in shed blood. The concentrations were higher than the circulating levels (P < 0.05). The filtration procedure did not significantly reduce the concentrations. 5. Transfusion of the shed blood did not significantly alter the circulating concentrations of C3a, SC5b-9, TNF-alpha, IL-1beta, and IL-8. The plasma concentrations of IL-6 were increased both 1 and 60 min after completed transfusion compared to before (P < 0.05). 6. This study shows that whole blood collected from a surgical wound contains large concentrations of complement split products and proinflammatory cytokines. Transfusion of shed blood leads to elevated plasma levels of IL-6.

Greater increase in cytokine concentration after salvage with filtered whole blood than with washed red cells, but no difference in postoperative hemoglobin recovery

BACKGROUND: Inflammatory mediators are released in association with intraoperative and postoperative salvage of blood. Whether these mediators (cytokines) participate in the modulation of erythropoiesis or not has been investigated.

Activation of the complement system by different autologous transfusion devices : an in vitro study

BACKGROUND : The aim of the present investigation was to study whether autologous transfusion devices activate the complement system and whether complement‐activated blood is more vulnerable to further activation during processing.

Decreased respiratory depression during emergence from anesthesia with sevoflurane/N2O than with sevoflurane alone

PurposeTo investigate ventilation and gas elimination during the emergence from inhalational anesthesia with controlled normoventilation with either sevoflurane/N2O or sevoflurane alone.MethodsTwenty-four ASA I–II patients scheduled for abdominal hysterectomy were randomly allocated to receive either 1.3 MAC sevoflurane/N2O (n= 12) or equi-MAC sevoflurane (n= 12) in 30% oxygen (O2). Expired minute ventilation volumes (VE), end-tidal (ET) concentrations of O2, carbon dioxide (CO2), sevoflurane and N2O as well as pulse oximetry saturation (SpO2) and CO2 elimination rates (VCO2) were measured. The ET concentrations of sevoflurane and N2O were converted to total MAC values and gas elimination was expressed in terms of MAC reduction. Time to resumption of spontaneous breathing and extubation were recorded and arterial blood gas analysis was performed at the end of controlled normoventilation and at the beginning of spontaneous breathing.ResultsResumption of spontaneous breathing and extubation were 8 and 13 min less, respectively, in the sevoflurane/N2O than in the sevoflurane group. Spontaneous breathing was resumed in both groups when pH had decreased by 0.07–0.08 and PaCO2 increased by 1.3–1.5 kPa. Depression of VE and VCO2 were less, and MAC reduction more rapid in the sevoflurane/N2O than in the sevoflurane group.ConclusionsRespiratory recovery was faster after sevoflurane/N2O than sevoflurane anesthesia. Changes in pH and PaCO2 rather than absolute values were important for resumption of spontaneous breathing after controlled normoventilation. In both groups, the tracheas were extubated at about 0.2 MAC.RésuméObjectifObserver la ventilation et l’élimination des gaz pendant la récupération de l’anesthésie par inhalation avec une normoventilation contrôlée, en utilisant un mélange de sévoflurane/N2O ou seulement du sévoflurane.MéthodeVingt-quatre patientes ASA I–II, dont l’hystérectomie abdominale était prévue, ont été réparties au hasard pour recevoir soit 1,3 CAM de sévoflurane/N2O (n = 12) ou la CAM équivalente de sévoflurane (n = 12) dans 30 % d’oxygène (O2). On a pris les mesures suivantes: volumes expirés de ventilation-minute (VE), concentrations d’O2 de fin d’expiration, gaz carbonique (CO2), sévoflurane et N2O, saturation en oxygène par oxymétrie puisée (SpO2) et vitesses d’élimination du CO2 (VCO2). Les concentrations de sévoflurane et de N2O de fin d’expiration ont été transformées en valeurs de CAM totales et l’élimination des gaz a été exprimée en termes de réduction de CAM. Le temps nécessaire au retour de la respiration spontanée et à l’extubation a été noté, l’analyse des gaz du sang artériel a été réalisée à la fin de la normoventilation contrôlée et au début de la respiration spontanée.RésultatsLe retour de la respiration spontanée et l’extubation ont demandé 8 et 13 min de moins, respectivement, avec le sévoflurane/N2O qu’avec le sévoflurane seul. La reprise de la respiration spontanée s’est faite dans les deux groupes après une baisse du pH de 0,07 – 0,08 et une augmentation de la PaCO2 de 1,3 – 1,5 kPa. La baisse de VE et de VCO2 a été moindre avec le sévoflurane/N2O, mais la réduction de CAM a été plus rapide avec le sévoflurane/N2O.ConclusionLa récupération respiratoire s’est faite plus rapidement après l’anesthésie avec un mélange de sévoflurane/N2O qu’avec du sévoflurane employé seul. Les changements de pH et de PaCO2, plutôt que les valeurs absolues, ont été importants pour le retour de la respiration spontanée après la normoventilation contrôlée. Dans les deux groupes, l’extubation a été faite à environ 0,2 CAM.

Continuous non-invasive monitoring of energy expenditure, oxygen consumption and alveolar ventilation during controlled ventilation: validation in an oxygen consuming lung model.

Background: We have developed a combined indirect calorimetric and breath‐by‐breath capnographic device (GEM) for respiratory monitoring: oxygen consumption (V̇O2), carbon dioxide excretion (V̇CO2), respiratory quotient (RQ), energy expenditure (EE), alveolar ventilation (V̇A) and dead space/total ventilation (VD/VT).

Increased serum erythropoietin concentration after allogeneic compared with autologous blood transfusion

Serum erythropoietin (sEPO) level is known to increase as hemoglobin (Hb) concentration decreases during and after preoperative autologous blood donation (PAD). The endogenous erythropoietin (EPO) production after allogeneic blood transfusion has not to our knowledge, been studied. The aim of the present study was to determine whether there is, after surgery, any change in sEPO concentration after allogeneic blood transfusion, and whether there is any difference in EPO response after autologous or allogeneic blood transfusion. Thirty-one patients approaching total hip-joint replacement surgery, were randomized to receive either allogeneic red blood cells (n = 15) or predeposited autologous whole blood transfusion (n = 16). The relationship between Hb, sEPO, and reticulocytes in the recipients were repeatedly analyzed before, during and after surgery. The Hb followed an expected pattern, with a decreased concentration after PAD in the autologous group, then in both groups after surgery. The sEPO concentration was significantly higher in the allogeneic than in the autologous group on day one and day 4-5 postoperatively. The reticulocyte level, on the contrary, was higher in the autologous patients before, one hour after, and one day after surgery. The study showed a greater increase in sEPO concentration after allogeneic blood transfusion than after autologous blood transfusion. There may be an inverse relationship between sEPO and the reticulocyte level.