Influence of acid-citrate-dextrose anticoagulant on blood quality in retransfusion systems after total knee arthroplasty

Abstract.

The influence of acid-citrate-dextrose (ACD) anticoagulant on the blood quality was assessed in this prospective, randomized, controlled study. The clinical consequences with regard to retransfusion of drainage blood following total knee arthroplasty were evaluated. After total knee arthroplasty, retransfusion was performed utilizing a ''SureTrans'' retransfusion system in 81 patients. In 42 of them, blood was collected adding an ACD anticoagulant (group A), while in the remaining 39 patients blood was collected without any additives (group B). Blood losses were retransfused over a 6-h period after attaching the retransfusion system to the patient of either group. Blood samples of the 6-h blood collection were taken and analysed for several blood quality parameters. Significant differences were found in the platelet count (61,200±16,700 µl^–1 in group A versus 70,100±21,600 µl^–1 in group B, p=0.042), the lactate concentration (4.09±0.86 mmol/l vs 4.82±0.83 mmol/l, p<0.001), the pH (6.96±0.10 vs 7.18±0.06, p<0.001), as well as the protein content (5.44±0.57 g/dl vs 5.85±0.43 g/dl, p<0.001). These observed significant differences were, however, of no clinical relevance to the patients' treatment. Hemoglobin concentration, hematocrit, mean corpuscular volume (MCV), erythrocyte count, leukocyte count, concentration of free hemoglobin in the blood plasma (fHb), potassium concentration, lactate dehydrogenase (LDH), serotonin concentration, triglyceride concentration, free fatty acid concentration, and interleukin-6 concentration did not differ significantly. This study indicates that the blood quality in retransfusion systems is not substantially influenced by adding ACD anticoagulant.