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The Annals of Thoracic Surgery, Vol 49, 585-589, Copyright © 1990 by The Society of Thoracic Surgeons
JW Jones, TA McCoy, RE Rawitscher and DA Lindsley
Intraoperative platelet-rich plasmapheresis allows autotransfusion of
fresh, undamaged platelets and clotting factors at the completion of the
operation. To evaluate this technology, we randomly assigned 100
consecutive patients who were to undergo an elective coronary bypass
procedure and had normal clotting studies into the experimental
(plasmapheresis) or the control group. Characteristics of both groups were
similar, including average age (61.4 years versus 61.3 years [experimental
versus control group]), sex (78% male versus 74% male), preoperative weight
(80.9 kg versus 80.2 kg), preoperative red cell mass (1,989 mL versus 1,890
mL), perfusion time (102 minutes versus 106 minutes), and coagulation
studies. Both internal mammary arteries were used in 68% of the patients.
All patients had preoperative and postoperative blood volume determinations
and complete clotting studies. Sixty-two variables related to bleeding were
analyzed. Strict indications for transfusion were a hemoglobin level less
than 7 g/100 mL in patients younger than 70 years and a hemoglobin level
less than 8 g/100 mL in patients older than 70 years. The group receiving
intraoperative plasmapheresis had a significant reduction in operative red
cell mass loss (1,050 +/- 43 mL versus 1,226 +/- 61 mL; p = 0.021), a
reduction in the average homologous transfusion (0.67 +/- 0.15 unit versus
1.8 +/- 0.25 units; p = 0.0002), and an increase in the percentage of
patients not requiring blood transfusions (66% versus 32%; p = 0.001). This
technique is useful in reducing postoperative blood loss and homologous
transfusions.
ARTICLES
Effects of intraoperative plasmapheresis on blood loss in cardiac surgery
Ritter Heart Institute, Toledo Hospital, Ohio.
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