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Canadian Journal of Anesthesia

, Volume 48, Issue 3, pp 251–255 | Cite as

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

  • Iréne AnderssonEmail author
  • Maria Tylman
  • Jan Peter Bengtson
  • Anders Bengtsson
General Anesthesia

Abstract

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.

Keywords

Free Hemoglobin Complement Split Product Wound Blood Patient Receive Platelet Transfusion Drainage Suction System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: 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.

References

  1. 1.
    Ereth MH, Oliver WC Jr,Santrach PJ. Perioperative interventions to decrease transfusion of allogeneic blood products. Mayo Clin Proc 1994; 69: 575–86.PubMedGoogle Scholar
  2. 2.
    Weiskopf RB. More on the changing indications for transfusion of blood and blood components during anesthesia (Editorlal). Anesthesiology 1996; 84: 498–501.PubMedCrossRefGoogle Scholar
  3. 3.
    Williamson KR, Taswell HF. Intraoperative blood salvage: a review. Transfusion 1991; 31: 662–75.PubMedCrossRefGoogle Scholar
  4. 4.
    Bengtsson A, Bengtson JP. Autologous blood transfusion: preoperative blood collection and blood salvage techniques. Acta Anesthesiol Scand 1996; 40: 1041–56.CrossRefGoogle Scholar
  5. 5.
    Krohn CD, Reikerås O, Aasen AO. Inflammatory cytokines and their receptors in arterial and mixed venous blood before, during and after infusion of drained untreated blood. Transfus Med 1999; 9: 125–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Arnestad JP, Bengtsson A, Bengtson JP, Johansson S, Redl H, Schlag G. Release of cytokines, polymorphonuclear elastase and terminal C5b-9 complement complex by infusion of wound drainage blood. Acta Orthop Scand 1995; 66: 329–33.CrossRefGoogle Scholar
  7. 7.
    Krohn CD, Reikerås O, Mollnes TE, Aasen AO. Complement activation and release of interleukin-6 and tumour necrosis factor- in drained and systemic blood after major orthopaedic surgery. Eur J Surg 1998; 164: 103–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Arnestad JP, Bengtsson A, Bengtson JP, Tylman M, Redl H, Schlag G. Formation of cytokines by retransfusion of shed whole blood. Br J Anaesth 1994; 72: 422–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Busund R, Balteskard L, Rönning G, Høgåsen K, Revhaug A. Fatal myocardial depression and circulatory collapse associated with complement activation induced by plasma infusion in severe porcine sepsis. Acta Anesthesiol Scand 1995; 39: 100–8.Google Scholar
  10. 10.
    Blevins F T, Shaw B, Valeri C R, Kasser J, Hall J. Reinfusion of shed blood after orthopaedic procedures in children and adolescents. J Bone Joint Surg 1993; 75-A: 363–71.Google Scholar

Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Iréne Andersson
    • 1
    Email author
  • Maria Tylman
    • 1
  • Jan Peter Bengtson
    • 1
  • Anders Bengtsson
    • 1
  1. 1.Department of Anesthesiology & Intensive CareEast Hospital, Sahlgrenska University HospitalGothenburgSweden

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