Tawes R L, Duvall T B
Department of Surgery, Mills-Peninsula Hospital, Burlingame-San Mateo, California, USA.
Am J Surg. 1996 Aug;172(2):172-4. doi: 10.1016/S0002-9610(96)00144-4.
Intraoperative autotransfusion (IAT) has been implicated in anecdotal cases and experimental models to precipitate, aggravate, or exacerbate a coagulopathy. This study assesses this hypothesis.
A retrospective database review of over 36,000 multispecialty cases of IAT during an 18-year experience was conducted with special reference to the occurrence of coagulopathy (disseminated intravascular coagulation [DIC]) in association with adult respiratory syndrome (ARDS).
The incidence of coagulopathy was low (0.05%). A total of 18 cases of DIC/ARDS were identified: 10 associated with ruptured aneurysms, 6 following massive trauma, and 2 after complex redo cardiac surgery. All 18 patients suffered shock and profound hypothermia. The mean transfusion requirement was 28 units. The mortality was 100%.
Although some degree of bleeding and clotting disorders are not uncommon in major cases, in our experience coagulopathy occurs infrequently and is a result of a complex interaction of shock, hypothermia, and multiple transfusions. It is our contention that these factors trigger the DIC, not the autotransfusor, and that the ARDS results from reperfusion injury following a profound ischemic event, associated in many cases with multiorgan failure.
