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Stationary Versus Agitated Storage of Whole Blood During Acute Normovolemic Hemodilution

Lu, Shu Yang*; Konig, Gerhardt MD*; Yazer, Mark H. MD; Brooks, Jay P. MD; Chen, Yi-Fan§; Jeong, Jong-Hyeon PhD§; Waters, Jonathan H. MD‖¶

doi: 10.1213/ANE.0000000000000046
Cardiovascular Anesthesiology: Research Report

BACKGROUND: Acute normovolemic hemodilution is an intraoperative technique to reduce the number of red blood cells lost in shed blood during surgery. Standard guidelines for storage of platelets recommend constant gentle agitation to maintain gas exchange for the metabolically active platelets. The collected whole blood (WB) for acute normovolemic hemodilution remains stationary for as long as 8 hours before reinfusion. We hypothesized that gentle agitation of WB throughout storage would improve the coagulation properties of the WB at the time of reinfusion.

METHODS: WB was collected from 10 volunteer donors and control samples taken. The units were split in 2 storage groups: agitated (rocked) and stationary (unrocked). Cell counts and fibrinogen levels, as well as thromboelastography (TEG®) measurements, including TEG® PlateletMapping® assays, were performed on the control sample and the test samples after 8 hours of rocked or unrocked storage at room temperature.

RESULTS: Nine units WB from 9 different healthy volunteers were tested. There were no significant differences in hematocrit, hemoglobin, red blood cells counts, platelet counts, or fibrinogen levels between the control samples and the rocked and unrocked WB samples. WB coagulation as measured by TEG® was preserved during the 8-hour storage period in both the rocked and unrocked samples. There were no significant differences between the control, rocked, and unrocked samples in time to initiate clotting, time of clot formation, rate of clot formation, or maximum strength of clot values. There were also no significant differences in the fibrin contribution to clot strength between the control, rocked, and unrocked samples, and no significant difference between the platelet activation from adenosine diphosphate or arachidonic acid among any of the 3 groups.

CONCLUSIONS: Given the small sample size, there is no statistical evidence on which to reject the null hypothesis of there being no difference in the changes from the baseline between coagulation function as measured by TEG® between WB that is either agitated or kept stationary for 8 hours. These findings need to be confirmed in a larger study.

From the *Department of Anesthesiology, University of Pittsburgh School of Medicine; Department of Pathology, University of Pittsburgh, and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania; Departments of Immunology and Laboratory Medicine, University of Florida College of Medicine, Shands Hospital, Gainesville, Florida; §Department of Biostatistics, University of Pittsburgh Graduate School of Public Health; Departments of Anesthesiology and Bioengineering, University of Pittsburgh School of Medicine; and McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Accepted for publication October 11, 2013.

Funding: This study was funded by grants from the Blood Sciences Foundation, Pittsburgh, PA, and the National Institutes of Health (T32GM075770, UL1RR024153, and UL1TR000005).

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Jonathan H. Waters, MD, Department of Anesthesiology, Magee Womens Hospital, 300 Halket St., Suite 3510, Pittsburgh, PA 15213. Address e-mail to

© 2014 International Anesthesia Research Society