[Clinical aspects of autologous blood donation in cardiosurgery].

The paper presents auto donation protocols and a procedure for autodonor plasmapheresis used in cardiosurgical patients, complications, and their preventive measures on the basis of an analysis of 308 autodonor plasmapheresis procedures performed at the Russian Surgery Research Center, Russian Academy of Medical Sciences, in 2007. The preoperative autoblood preservation safety concept envisaging the safety of autodonors during blood donation, the correct storage and issue of autocomponents, and the prevention of adverse reactions to blood exfusion in patients was introduced. The rate of the reactions was 6.4% of the total number of auto donations in cardiosurgical high-risk patients, moderate reaction being most common. The findings indicated that exfusion of 450 ml of blood without previous infusion of plasma substitutes was a cause of collaptoid reactions in 14 cases of the collapse-complicated procedures of autodonor plasmapheresis in cardiosurgical patients (in 70% of the total number of complications). No association was found between of the frequency and severity of complications and the nosological entity, age, and body mass index; however, a further retrospective analysis of 1500 fresh frozen autoblood preservation procedures that have recently made at the Russian Surgery Research Center, Russian Academy of Medical Sciences, is required to have statistically significant data.

[Ways of reducing donor blood components during reconstructive surgery of the heart valves under extracorporeal circulation].

Blood loss and transfusion tactics were analyzed in 131 patients who had undergone correction of one, two, and three cardiac valves under general balanced anesthesia and extracorporeal circulation. The volume of intraoperative blood loss was 869+/-298 ml with the range of 700 to 2000 ml. Packed red cells (PRC) were transfused to 9% of patients; fresh frozen plasma (FFP) in 10%, PRC and FFP were transfused to 17% patients. Donor blood was not used in 63.5% of patients in order to save the patient's blood. It comprised the preoperative storage of autologous plasma in a quantity of 300-700 ml, the modified intraoperative reservation of autologous blood in a volume of 400-1200 ml, and, in 70% of patients, the use of washed autologous red blood cells. The hemostasis protocol included the use of epsilon-aminocapronic acid, aprotinin (trasilol) not more than 2,000,000 KUE, and packed platelets. For adequate heparin neutralization, after administration of the calculated dose of protamine, it was long administered in a dose of 25 mg/hour for 4-5 hours. The developed and introduced comprehensive program for the patient's blood maintenance and blood loss diminution made it possible to avoid transfusing PRC and FFP in more than 60% of patients with a blood loss volume of as high as 1500 ml; and to maintain adequate oxygen balance and hemostasis in the remaining patients.