Resumo

INDUNI LOPEZ, Eduardo; ALVARADO, Manuel; MENDEZ, Edgar  e  PUCCI, Juan. Autotransfusión y terapia de componentes sanguíneos autológos en cirugía cardíaca: consideraciones generales y experiencia en el Hospital México. Rev. costarric. cardiol [online]. 2003, vol.5, n.1, pp.9-18. ISSN 1409-4142.

Introduction: Blood auto transfusion and autologeous blood component therapy has been a modality that has been used for more than 2 centuries, and experiences, thanks to recent technical advances, its implementation in maneuvers which lead to saving and eliminating blood loss in extensive surgical procedures, as well as the inherent risks to the transfusion homologate.   Objectives: To reduce the number of days of hospital stay in patients getting ready for extracorporeal surgery, and to use preoperatory plateletpheresis and biological platelet glues to reduce bleeding and transfusion requirements in heart surgery.   Material and methods: Of the patients submitted to heart surgery with extracorporeal circulation in the México Hospital during the period of February 1997 to February 2003, the autotransfusion of red cells was used by recovery in a total of 150 patients. To each of them was performed an autotransfusion of washed red cells for which was used a Cell Saver type machine, Secuestra1000, (Medtronic, Minneapolis, Mn.). Included were patient with heart re-do, multiple or complicated coronary surgery, anemic patients or of strange sanguine groups without possibility of obtaining blood, and Jehova's Witness patients as part of the surgery protocol. Patients with complex surgeries and without previous heparinization underwent preoperative platelet sequestration besides the confection of sealing gel rich in platelet concentrate. Extracorporeal circulation was carried out with moderate hypothermia in all patients except for one with a complex surgery where circulatory arrest was required with profound hypothermia. Relating data to the pre, trans and post surgery hematocrit were gathered, as well as the number of component units obtained, analyzing other related variables.   Results: A total of 225 surgeries in 150 patients were carried out for an average of 1.5 procedures per patient. Of the 150 operated patients, 100 were men (66%) and 50 were women (33%). The average age was 47.8 + 22.8 -34.8. Twenty six patients were Jehovah’s Witness and their participation was indicated under the condition that they were not to be transfused. A total of 317.76 liters of aspired sample was processed from the operation field.   A total of 156.45 liters of red globules were recovered from the aspired sample, corresponding to an average of 1043 cc per patient. To 26 patients was carried out a pre surgery plateletpheresis and plasmapheresis, obtaining a total of 11,000 cc of fresh plasma, for an average of 423.07 cc, and 5,600 cc of platelets (215.38 cc per patient). Platelet rich gel was made in twenty patients, and used to seal bleeding sites in resurgeries, aortic aneurism and in cardiotomy sutures, obtaining an average of 64.28 cc of clear platelet gel per patient.   The hemostasis was successful in all the patients after the application. A total of 30 bank units were processed to separate the red cells. None of the patients submitted to pre surgery plateletpheresis required transfusion of additional platelets or fresh plasma. The pre surgery platelet counts were an average of 207,000pks/mm3 and the post surgery control count was 203,000pks / mm3. One observes a decrease in the average post surgery bleeding from 740 cc, to 230 cc in those submitted to plateletpheresis obtaining almost 70% less bleeding in the thoracic drains.   To the Jehova's Witness patients, an average of 650 cc was processed in relation to the general average of 1043 cc. The required homologous transfusion in the post surgery patient was of 0.9 units compared to 4.1 units used normally by a patient representing a reduction of more than 70%. The pre surgery hematocrit was of 38.3% and during hemodilution by extracorporeal circulation an average of 20.5% was obtained, and in the immediate post surgery a 31% was obtained. The pre surgery stay was of 2 days in auto transfusion patients compared to a 6.2 average when blood donors were required, and the postoperative stay was 7 and 7.2 days respectively.   Conclusions: The present study shows a novel method for sanguine saving, which holds not only great importance in the economical environment due to the reduction in hospital days before and after surgery, but also for eliminating the broadly and well-known risks of homologous transfusion. The transfusion requirements of RBC were reduced up to 70% and those for platelets were eliminated entirety. Also post surgery bleeding decreased significantly in 68% in patients with plateletpheresys, adding to that the 100% effectiveness of the platelet gel.   Without a doubt this experience reveals a procedure with a wide horizon of therapeutic uses and encouraging results seen from the perspective of the blood saving technicians.

Palavras-chave : Heard Surery; Auto -transfussion; Blood Save Technical; Autologous transfussion.