Abstract
Introduction and Aims: Reinfusion drains have been used to decrease the need for blood transfusion following total knee replacement. The aim of this study was to evaluate the degree of activation of platelets and leucocytes in both the blood that has been salvaged after total knee arthroplasty and the patients’ blood following reinfusion.
Method: A prospective series of 24 consecutive patients undergoing a primary total knee replacement in a case-control study were investigated. Post-operatively 12 patients received salvaged blood reinfusion and as a control, 12 patients underwent TKA with a standard drain. The reinfusion was initiated four hours after the operation. Blood samples were taken from all patients at three and five and a half to six hours post-operatively. A third sample was acquired in the treatment group from salvaged blood after reinfusion. Platelet, platelet-leucocyte and leucocyte activation markers were studied in both the drainage blood and the patients’ blood following reinfusion.
Results: Comparison between platelet, platelet-leucocyte and leucocyte activation markers in patients’ circulation prior to reinfusion compared to salvaged blood showed that almost all markers were significantly increased in salvaged blood. For example the platelet activation markers P-selectin (p< 0.01), Factor V (p< 0.01), CD40L (p< 0.01) and platelet derived microparticles (p< 0.01) were all significantly increased in the drainage blood. All studied platelet-leukocyte and leucocyte activation particles were also significantly increased. Following re-infusion of autologous salvaged blood there was no statistically measurable effect on activation markers of patients’ circulating platelets and leucocytes, but there was a slight drop in platelet count in the reinfused group compared to the control group. Levels of prothrombin fragment F 1+2 increased in the reinfused group compared to control indicating either activation of coagulation or simply the effect of addition of the high levels present in the salvage blood.
Conclusion: Blood from reinfusion drains showed a significant increase in activation of platelets and leukocytes indicating activation of coagulation. The reinfused blood did not lead to a difference in platelet and leukocyte activation but a decrease in platelets and an increase in fragment F1+2 suggests the possibility of activation of coagulation.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
None of the authors is receiving any financial benefit or support from any source.
