Unwashed wound drainage blood. What are we giving our patients?

Wound drainage blood was collected after total joint arthroplasty was completed in 13 consecutive patients. Peripheral blood samples were collected in the recovery room and at 6 hours postoperatively for all 13 patients. A standard enzyme-linked immunosorbency assay was done to quantify tumor necrosis factor-alpha, interleukin-1 alpha, interleukin-6, and interleukin-8 levels in the samples. At 6 hours postoperatively, the levels of cytokines were elevated significantly in the peripheral and drainage blood serum. In particular, the drainage blood serum had the most dramatic increase for all cytokines, which was significant. Reinfusion of unwashed filtered postoperative wound drainage blood has been shown not to be entirely benign; pyrogenic transfusion reaction is the most commonly reported adverse effect, but hemodynamic instability with hypotension and even myocardial infarction have been reported. The cause of these adverse events has not been defined clearly, but may be secondary to the infusion of cytokines. The present study showed the presence and significant elevation of the cytokine levels in the wound drainage blood. A comprehensive review of the literature revealed that unwashed drainage blood is a relatively dilute blood product lacking normal clotting factors and having numerous other undesirable components that may mitigate against its routine use in lieu of predeposited autologous or homologous blood. This is of interest because there is evidence indicating that wound drainage blood reinfusion may be unnecessary in total joint arthroplasty when autologous blood is available. Use of drains in this surgery also may be unnecessary and has been shown to increase the amount of blood loss and the need for transfusion.