Assessment of complement activation in autologous blood during cardiac surgery

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ASSESSMENT OF COMPLEMENT ACTIVATION IN AUTOLOGOUS BLOOD DURING CARDIAC SURGERY B.H. Walpoth', M. Niklesl, P.J. Spaeth', U.E. Nydegger3, U. Althausl Dept. of Thoracic and Cardiovascular Surgeryl, Ha5mathology3, University of Berne, Central Laboratory Blood Transfusion Services SRC , 3010 Berne, Switzerland

PERIOPERATIVE Several methods of blood salvage are used in cardiac surgery (1). Our aim was to study, on the basis of complement activation, the quality of autologous blood products reinfused to the patient. Eleven patients with elective myocardial revascularisation were studied with institutional committee approval and verbal informed consent for: operative and cardiopulmonary bypass (CPB) data, haemstology, blood chemistry and complement activation (C3a[des Argl and terminal complement complex (TCC or C5b-9 complex) (2, 3). Centrifuged oxygenator blood (COB) and shed mediastinal blood (SMB) samples were examined before reinfusion into the patient and the effect of the retransfusion on the systemic values was analysed (represented for a typical patient in the adjacent figure). The activation pattern for C3a(des Arg] and TCC were similar. Thus only evaluation of C3a[des Argl is reported (mean values + 1 SD; significance by student's T-Test): Timing C3a[des Argl standardized by IgG baseline values (ng/ml/g IgG) Baseline Following Induction of anaesthesia

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Time Points of systemic blood value: 1: BSSSlinS, 2: Following Induction of anaesthesia, 3: 1 hr on CPB, 4: ICU Arrival, 5: AfterCOB, 6: after SMB, 7: POD 1, (C3a . .... . and TCC -1

We conclude that despite detectable complement activation in autologous blood products to be reinfused no increase in C3a(des Argl is seen in the patient's circulation. This might be explained either by the very potent clearing capacity of the body or the rapid absorption of C3a[des Argl by cellular receptors.

85264 REFERENCES

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1. Walpoth, B.H., Volken U., Pfaeffli T ., Muehlemann W., Jutzi H., Nydegger U., Althaus U.: Quantitative and qualitative assessment of various methods of blood salvage during cardiac surgery. Schwez med Wschr, 120, 817-822. 1990

2. Oeveren,van W.. Kazatchkine M.D., -pco,o1

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Descamps-Latscha B., Maillet P., Fischer E., Carpentier A., Wildevuur C.R.H.: Deleterious effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg, 89, ES&889, 1985 3. Mollnes. T.E., Lea T., Froland S.S., Harboe M.: Quantification of the terminal complement complex in human plasma by an Enzyme-linked immunoabsorbent assay based on monoclonal antibodies against a neaoantigen of the complex. Stand J Immun, 22, 197-202-1985