Proinflammatory cytokines and complement activation in salvaged blood from abdominal aortic aneurism surgery and total hip replacement surgery

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2012-08, Vol.52 (8), p.1761-1769
• Main Authors: Lindholm, Espen, Seljeflot, Ingebjørg, Aune, Erlend, Kirkebøen, Knut Arvid
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta; Aortic Aneurysm, Abdominal - blood; Aortic Aneurysm, Abdominal - surgery; Arthroplasty, Replacement, Hip; Biological and medical sciences; Blood Transfusion, Autologous; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; C-Reactive Protein - metabolism; Complement Activation - immunology; Complement C3a - metabolism; Female; Humans; Inflammation Mediators - blood; Interleukin-1beta - blood; Interleukin-6 - blood; Interleukin-8 - blood; Male; Medical sciences; Middle Aged; Operative Blood Salvage; Postoperative Complications - blood; Postoperative Complications - immunology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Tumor Necrosis Factor-alpha - blood
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2011.03528.x

BACKGROUND: Levels of proinflammatory mediators in unwashed salvaged blood from abdominal aortic aneurism (AAA) surgery are unknown. We hypothesized that there are higher levels of these mediators in unwashed blood salvaged in AAA surgery compared to hip replacement surgery. STUDY DESIGN AND METHODS: Ten patients scheduled for AAA surgery (Group A) and 10 patients for total hip replacement surgery (Group H) were included. Blood samples from the autotransfusion set were obtained during surgery and arterial samples before, during, and 6 hours after surgery. Determination of interleukin (IL)‐1β, IL‐6, IL‐8, tumor necrosis factor‐α, activated complement 3 (C3a), and high‐sensitivity C‐reactive protein (CRP) were performed. Salvaged blood was not retransfused. RESULTS: Levels (median [range]) of IL‐8 in blood in the salvage system were higher in Group A versus Group H (215.3 [22.5‐697.2] vs. 35.3 [16.7‐66.6] pg/mL; p = 0.002). Higher levels of IL‐6 were also seen in Group A versus Group H (60.0 [52.6‐62.2] vs. 42.34 [19.4‐62.2] pg/mL; p = 0.049). Levels of IL‐6 in blood sampled during surgery were approximately fivefold higher in Group A versus Group H (p = 0.023), whereas approximately 70% higher levels of C3a were observed in Group H versus Group A (p = 0.021). Postoperative concentrations of IL‐1β (p = 0.002), IL‐6 (p = 0.001), and IL‐8 (0.005) were higher in Group A versus Group H. CONCLUSION: Salvaged blood in AAA surgery contains substantially higher levels of proinflammatory mediators compared to blood in total hip replacement surgery.