A Cytokine Analysis of the Effect of Cell Saver on Blood in Coronary Bypass Surgery

Abstract

Background: Increasing concern about the transmission of viral disease has generated greater interest in the use of salvaged blood as a means of alleviating the demand for homologous blood and expediting resuscitation during massive hemorrhage. Autologous blood processed by auto-transfusion devices has become increasingly common in major surgery and is now largely viewed as safe and efficacious. However, there may be serious complications and sequelae associated with the use of processed blood, such as adult respiratory distress syndrome (ARDS) and renal failure. Complement cascade activation resulting from blood coming into contact with autotransfusion equipment leads to enrollment of leukocytes and release of large concentrations of cytokines, which may contribute to the development of organ failure. Our study evaluated cyto-kine release during cell saver (CS) blood salvage in the course of coronary artery bypass grafting (CABG) surgery.

Materials and Methods: Forty-five patients randomly selected for CABG were evaluated. All had received at least one unit of autotransfused blood by means of the Haemonetics Cell Saver® System 5 (Haemonetics Corp., Braintree, MA). Each patient had four blood samples taken (pre-operative, CS container, autotransfusion from the blood bag, and one hour post-transfusion). These samples were then centrifuged and the sera were collected. An enzyme linked immunosorbent assay (ELISA) test, using the Biosource Cytoscreen solid phase “sandwich” ELISA kit (Biosource International, Camarillo, CA) was conducted to determine levels of the cytokines Interleukin (IL) 1, 2, 4, 6, 8, and 10, tumor necrosis factor (TNF), intracellular adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM).

Results: Significantly increased concentrations of the pro-inflammatory cytokines IL-1, 2, 4, 6, and 8, TNF, ICAM, and VCAM were noted throughout all time periods studied. The same effect was observed for the anti-inflammatory cytokine IL-10.

Conclusion: Statistically significant increases in both the circulating levels of the pro-inflammatory and anti-inflammatory cytokines studied were recorded. It is our contention that the presence of IL-10, a down-regulator of inflammation, is responsible for attenuating the possible deleterious effects of the pro-inflammatory cytokines observed. However, morbidity and mortality, as well as the future patency of the bypass grafts, have not been correlated with the use of the autologous method of transfusion.