Study objectives: This study was conducted to
investigate whether intraoperative blood transfusions affect the
release of proinflammatory mediators in patients undergoing cardiac
surgery. Therefore, we measured plasma levels of bactericidal
permeability increasing protein (BPI) as a marker of neutrophil
activation, interleukin-6 (IL-6), lipopolysaccharide binding protein
(LBP), and C-reactive protein (CRP). In addition, these mediators,
except CRP, were also measured in packed red cell units (PCs)
administered to these patients.
Setting: Cardiopulmonary surgery department in
a university hospital.
Patients: One hundred fourteen
consecutive patients undergoing cardiac surgery.
Interventions: Blood samples were taken at induction of
anesthesia, at the start of aortic cross-clamping, at aortic
unclamping, and at 0.5, 4, 8, and 18 h thereafter.
Results: Thirty-six patients received PC
intraoperatively. BPI levels in patients who received transfusions were
significantly higher at 0.5 and 4 h after aortic unclamping than
in patients without transfusions (p < 0.05), and increased with the
number of PC administered. IL-6 levels at 0.5, 4, and 18 h after
aortic unclamping were also significantly higher in patients who
received transfusions (p < 0.01). BPI was found in all units of
packed red cells tested at concentrations up to 15 times preoperative
plasma levels in patients. However, PC IL-6 could be detected in none
of the samples. Plasma levels of LBP and CRP were similar in both
patient groups. LBP was found in very low concentrations in all PC.
Patients who received intraoperative transfusions had a worse
PC transfusions do contribute to the inflammatory response after
cardiac surgery both by enhancing part of the response and by directly
changing plasma concentrations of inflammatory mediators. Furthermore,
these data show that intraoperative PC transfusion is associated with a
worse postoperative performance.