By G. Singbartl, W. Schleinzer
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Extra info for Autologous Transfusion - From Euphoria to Reason: Clinical Practice Based on scientific knowledge - Nottwil, January 16-17, 2004: Proceedings
4 Birkmeyer JD, AuBuchon JP, Littenberg B, O’Connor GT, Nease RF Jr, Nugent WC, Goodnough LT: Cost-effectiveness of preoperative autologous donation in coronary artery bypass grafting. Ann Thorac Surg 1994;57:161–168. 5 Muirhead B: Con: Preoperative autologous donation has no role in cardiac surgery. J Cardiothorac Vasc Anesth 2003;17:126–128. 6 Chamberland ME: Emerging infectious agents: Do they pose a risk to the safety of transfused blood and blood products? Clin Infect Dis 2002;34:797– 805.
However, with respect to the only slight decreases these lesions probably do not have any clinical significance. In the few publications on this subject higher values of hemolysis during blood aspiration are reported . This corresponds to our finding of a much higher susceptibility of RBCs if stored, outdated banked blood is used for the experiments. Cell lesions due to negative pressure could be of special importance for postoperative autotransfusion of drainage blood like with the OrthoPAT system, since collection occurs in a closed system (no pressure release by air admixture) with constant suction for several hours.
Sufficient hematocrit is not only of major importance for tissue oxygenation but also for coagulation. Valeri et al.  showed that a decrease of only 15% in hematocrit is associated with a 60% prolonged bleeding time. In addition to rheology, the coagulation-active effect of erythrocytes might also be due to enhanced ADP release, stimulation of thromboxane A2 synthesis as well as enhanced thrombin generation by red blood cells [20–23]. At a hematocrit level of less than 20% critical impairment of hemostasis can be expected, with concomitant thrombocytopenia having a stronger effect on the coagulatory system .