Washing red blood cells and platelets transfused in cardiac surgery reduces postoperative inflammation and number of transfusions
Pediatric Critical Care, 05/15/2012
Cholette JM et al. – Washed blood transfusions in cardiac surgery reduced inflammatory biomarkers, number of transfusions, donor exposures, and were associated with a nonsignificant trend toward reduced mortality.Methods
- Children from birth to 17yrs undergoing cardiac surgery with cardiopulmonary bypass.
- Children were randomized to an unwashed or washed red blood cells and platelet transfusion protocol for their surgery and postoperative care.
- All blood was leuko–reduced, irradiated, and ABO identical.
- Plasma was obtained for laboratory analysis preoperatively, immediately, and 6 and 12hrs after cardiopulmonary bypass.
- Primary outcome was the 12–hr postcardiopulmonary bypass interleukin–6–to–interleukin–10 ratio.
- Secondary measures were interleukin levels, C–reactive protein, and clinical outcomes.
- One hundred sixty–two subjects were studied, 81 per group.
- Thirty–four subjects (17 per group) did not receive any blood transfusions.
- Storage duration of blood products was similar between groups.
- Among transfused subjects, the 12–hr interleukin ratio was significantly lower in the washed group (3.8 vs. 4.8; p=.04) secondary to lower interleukin–6 levels (after cardiopulmonary bypass: 65 vs.100pg/mL, p=.06; 6hrs: 89 vs.152pg/mL, p=.02; 12hrs: 84 vs.122pg/mL, p=.09).
- Postoperative C–reactive protein was lower in subjects receiving washed blood (38 vs. 43mg/L; p=.03).
- There was a numerical, but not statistically significant, decrease in total blood product transfusions (203 vs. 260) and mortality (2 vs. 6 deaths) in the washed group compared to the unwashed group.