[Pre and post-operative autotransfusion. A comparative study of hematology, biochemistry and red cell metabolism in pre-donated blood and blood from post-operative surgical drainage]. / Autotransfusión pre y postoperatoria. Estudio comparativo de la hematología, bioquímica y metabolismo eritrocitario en sangre predonada y sangre de drenaje postoperatorio.

PURPOSE: The widespread use of aggressive surgical procedures, along with the increasing incidence of traffic accidents, has raised the necessity of homologous blood beyond the supplies of blood banks. This fact, plus the risks of homologous transfusion and the costs of blood bank maintenance, has prompted the advance of blood saving procedures such as autotransfusion, both in the pre-deposit (preoperative autotransfusion, POA) and the surgical drainage reinfusion (postoperative autotransfusion, SDR) modalities. As there is some controversy about the use of one or the other of the above procedures, the purposes of this study were: 1) to analyse the haematological and biochemical characteristics of blood, both pre-donated and stored at 4 degrees C for 4 weeks, and that recovered from surgical drains, from patients subjected to programmed orthopaedic or heart surgery; 2) to assess the metabolic and functional state of red cells attained from that blood, and 3) to compare the results achieved. MATERIAL AND METHODS: The following data were examined: red cell count, haematocrit, haemoglobin, red cell indicates, white cell count, platelet count, free plasma haemoglobin, red cell morphology, glucose, cholesterol, triglycerides, phospholipids, serum proteins and their fractions, ions, histamine, red cell glucose and amino acid transport, and ATP and 2,3-DPG content. RESULTS: The red cells, haemoglobin and haematocrit concentrations in POA blood did not show significant variations during the storage for 4 weeks and their values were significantly higher than found in drained blood. The biochemical values showed heterogeneous variations. Glucose and amino acid uptake by red cells of POA blood slightly decreased in the first 2 weeks of storage but always less than measured in SDR red cells. In POA blood it was noticed a progressive decrease in intra-erythrocytic ATP and 2,3 DPG, those levels being normal in SDR. DISCUSSION: In spite of lower haematocrit and haemoglobin but higher free plasma haemoglobin content, drained blood had higher ATP and 2,3-DPG concentration than pre-deposit, stored blood. Drained blood showed also less ion alterations and probably a lesser immunosuppressor capability. Thus, postoperative blood recovery seems a good source of red cell, with high oxygen transport power, and so, alone or in combination with pre-donated blood, it may contribute to reduce the necessities for homologous blood and decrease its risks.

The dominant beta-thalassaemia in a Spanish family is due to a frameshift that introduces an extra CGG codon ( = arginine) at the 5' end of the second exon.

We have discovered a Spanish family with a dominant type of beta-thalassaemia. Carriers are characterized by mild anaemia, hypochromia, microcytosis, elevated Hb A2 and Hb F levels, reticulocytosis, and splenomegaly. The molecular basis of this condition is the introduction of a CGG triplet between codons 30 and 31 of the beta gene; this was determined by sequencing of amplified DNA and confirmed by dot-blot analysis. The abnormal mRNA (beta Th-mRNA) is stable and present in quantities similar to that of normal beta A-mRNA. cDNA fragments derived from beta Th- and beta A-mRNAs can be separated on a denaturing polyacrylamide gel electrophoresis because the beta Th fragment is three nucleotides (nts) longer than the beta A fragment. The beta Th-mRNA translates into a beta chain that is 147 amino acid residues long and carries an extra arginine residue between residues 30 and 31. This beta X chain has not been detected. It may be unstable and does not bind to the alpha chain. It probably is continuously digested by proteolytic enzymes in red cell precursors in the bone marrow. The abnormal chain probably binds haem that is excreted after proteolysis causing a darkening of the urine.