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Olsson, Anki
Publications (2 of 2) Show all publications
Olsson, A., Alfredsson, J., Ramstrom, S., Svedjeholm, R., Kenny, D., Hakansson, E., . . . Berg, S. (2018). Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique: a randomized pilot study. Perfusion, 33(3), 185-193
Open this publication in new window or tab >>Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique: a randomized pilot study
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2018 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 3, p. 185-193Article in journal (Refereed) Published
Abstract [en]

Introduction: Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques. Methods: Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles). Results: Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups. Conclusions: The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2018
Keywords
cardiopulmonary bypass, methods, hemostasis, platelet function tests
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:bth-16119 (URN)10.1177/0267659117733891 (DOI)000429907500003 ()28950757 (PubMedID)
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-04-26Bibliographically approved
Olsson, A., Alfredsson, J., Håkansson, E., Svedjeholm, R., Berglund, J. & Berg, S. (2015). Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass. Scandinavian Cardiovascular Journal, 50(1), 58-63
Open this publication in new window or tab >>Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass
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2015 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, p. 58-63Article in journal (Refereed) Published
Abstract [en]

Objectives: Platelet dysfunction is an important cause of postoperative bleeding after cardiac surgery. Protamine is routinely used for reversal of heparin after cardiopulmonary bypass (CBP), but may affect platelet aggregation. We assessed changes in platelet function in relation to protamine administration. Design: Platelet aggregation was analyzed by impedance aggregometry before and after protamine administration in 25 adult cardiac surgery patients. Aggregation was also studied after in vitro addition of heparin and protamine. The activators adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used. Results: Platelet aggregation was reduced by approximately 50% after in vivo protamine administration; ADP 640 ± 230 (AU*min, mean ± SD) to 250 ± 160, TRAP 939 ± 293 to 472 ± 260, AA 307 ± 238 to 159 ± 143 and COL 1022 ± 350 to 506 ± 238 (all p < 0.001). Aggregation was also reduced after in vitro addition of protamine alone with activators ADP from 518 ± 173 to 384 ± 157 AU*min p < 0.001, and AA 449 ± 311 to 340 ± 285 (p < 0.01) and protamine combined with heparin (1:1 ratio) with activators ADP to 349 ± 160 and AA to 308 ± 260 (both p < 0.001); and COL from 586 ± 180 to 455 ± 172 (p < 0.05). Conclusions: Protamine given after CPB markedly reduces platelet aggregation. Protamine added in vitro also reduces platelet aggregation, by itself or in combination with heparin. © 2015 Taylor & Francis

Place, publisher, year, edition, pages
Taylor & Francis, 2015
Keywords
cardiopulmonary bypass; platelet aggregation; platelet function tests; protamine
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:bth-11011 (URN)10.3109/14017431.2015.1099720 (DOI)000365693900009 ()2-s2.0-84944936680 (Scopus ID)
Available from: 2015-11-24 Created: 2015-11-24 Last updated: 2017-12-01Bibliographically approved
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