Sodium citrate effectively used in shed mediastinal blood autotransfusion after cardiac surgery

• Published in: Perfusion Vol. 39; no. 6; pp. 1106 - 1112
• Main Authors: Hao, Xinghai, Chen, Yueling, Wang, Liangshan, Jia, Ming, Lu, Yang
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-09-2024; Sage Publications Ltd
• Subjects: Aged; Anticoagulants; Anticoagulants - therapeutic use; Autotransfusion; Blood levels; Blood transfusion; Blood Transfusion, Autologous - methods; Blood transfusions; Calcium (blood); Calcium ions; Cardiac Surgical Procedures - methods; Citrates - pharmacology; Citric acid; Electrolytic cells; Female; Heart; Heart surgery; Hematocrit; Hemoglobin; Hemorrhage; Heparin; Humans; Ion concentration; Male; Middle Aged; Operative Blood Salvage - methods; Postoperative Hemorrhage - blood; Postoperative Hemorrhage - prevention & control; Postoperative Hemorrhage - therapy; Sodium; Sodium citrate; Sodium Citrate - pharmacology; Surgery; Transfusion; Washing; cell salvage; autotransfusion; cardiac surgery; Shed mediastinal blood; sodium citrate
• ISSN: 0267-6591; 1477-111X; 1477-111X
• DOI: 10.1177/02676591231171271

Background
We used sodium citrate as an alternative anticoagulation agent to heparin in the procedure of autologous blood transfusion with patients with postoperative haemorrhage after CPB. The aim of study was to evaluate the efficacy and safety of sodium citrate used in shed mediastinal blood autotransfusion after cardiac surgery.
Methods
Ninety-three patients were divided into two groups in this study. In the control group, 52 patients’ shed mediastinal blood was discarded. The reinfusion group consisted of 41 patients receiving a reinfusion of washed autologous red cells from shed mediastinal blood. Each 400 mL shed blood sample was anticoagulated by 140 mL of 1.6% diluted sodium citrate in the washing procedure using a blood recovery machine. Hemoglobin (Hb), hematocrit (Hct), and electrolyte concentrations in both the patients and shed mediastinal blood were measured before and after this procedure.
Results
The mean volume of autotransfused shed blood was 239.5 ± 54.6 mL.The Hct of the washed red cells was 56.8 ± 6.1%. Significantly, fewer units of allogeneic blood were required per patient in the reinfusion group at 24 h postoperatively (2.91 ± 1.34 vs 4.03 ± 0.19 U, p = 0.002). At 24 h postoperatively, Hb and Hct levels were higher in the reinfusion group than in the control group. The calcium ion concentration was very low in the shed mediastinal blood, 0.25 ± 0.08 mmol/L, and was lower after washing, 0.15 ± 0.04 mmol/L.
Conclusions
Sodium citrate, as an alternative anticoagulant agent, can be used in autologous shed mediastinal blood transfusion after CPB cardiac surgery. This procedure can effectively reduce the amount of allogeneic blood for patients with haemorrhage.