Kongsgaard U E, Hovig T, Brosstad F, Geiran O
Department of Anaesthesiology, Rikshospitalet, Oslo, Norway.
Acta Anaesthesiol Scand. 1993 Apr;37(3):265-8. doi: 10.1111/j.1399-6576.1993.tb03713.x.
Ten patients undergoing open-heart surgery received postoperative autotransfusion of shed mediastinal blood collected in the cardiotomy reservoir. The number, function and morphology of the platelets found in the shed blood were investigated. Platelets were counted using an electronic counter compared with light microscopy. Morphology of platelets was studied with electron microscopy. Platelet aggregation was studied using an aggregometer. Dense granule secretion was measured as the extracellular appearance of adenosine triphosphate. Enumeration of platelets in shed blood using the two methods gave different results. Thus, the electronic counter gave a mean platelet count of 62 x 10(9).l-1, while light microscopy revealed only a mean platelet count of 10 x 10(9).l-1. Electron microscopy disclosed few platelets, but numerous cytoplasmatic fragments smaller than or up to the same size as platelets. The platelets found were mostly shape-changed, spheroid, characterized by centralization and loss of alpha-granules and dense bodies, all changes that indicated irreversible platelet activation. The platelets failed to aggregate in response to the presence of thrombin, adenosine diphosphate or collagen, and secretion of adenosine triphosphate was absent. Plasma from the shed blood was not capable of inducing spontaneous aggregation in platelet-rich plasma from healthy donors. These results indicate that infusion of larger volumes of autotransfused blood should be supplemented with platelet concentrates.
10例接受心脏直视手术的患者术后接受了收集于心内直视手术储血器中的纵隔引流血自体输血。对引流血中血小板的数量、功能和形态进行了研究。使用电子计数器与光学显微镜计数血小板。用电子显微镜研究血小板形态。用血小板聚集仪研究血小板聚集。以三磷酸腺苷在细胞外的出现来测定致密颗粒分泌。用这两种方法对引流血中的血小板进行计数得到了不同的结果。因此，电子计数器测得的血小板平均计数为62×10⁹/L，而光学显微镜仅显示平均血小板计数为10×10⁹/L。电子显微镜显示血小板很少，但有许多比血小板小或与血小板大小相同的细胞质碎片。所发现的血小板大多形态改变，呈球形，其特征为α颗粒和致密体集中化并丢失，所有这些变化均表明血小板发生了不可逆的激活。血小板对凝血酶、二磷酸腺苷或胶原的存在无聚集反应，且无三磷酸腺苷分泌。引流血的血浆不能诱导健康供者富含血小板血浆的自发聚集。这些结果表明，输注大量自体输血时应补充血小板浓缩物。
