Fibrinogen and albumin deficiencies associated with packed red blood cell transfusions.
ABSTRACT Fibrinogen content was determined for each of 50 units of citrate-dextrose-phosphate (CPD)-preserved whole blood, packed red blood cells reconstituted with 250 ml. of saline, and packed red cells reconstituted with 250 ml. of purified plasma protein fraction (PPF). The total protein and albumin were measured, by electrophoresis, on each of 10 units of the three varieties of blood. The fibrinogen content of the two types of reconstituted cells was significantly lower than that of whole blood. Although the total protein/albumin content of whole blood and PPF-reconstituted red cells was similar, saline-reconstituted cells were markedly deficient in both total protein and albumin. Low fibrinogen and platelet levels subsequent to transfusion with reconstituted packed red cells can lead to an erroneous diagnosis of disseminated intravascular coagulation. Administration of large quantities of saline-reconstituted packed cells could be an etiologic factor in postoperative interstitial pulmonary edema.
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ABSTRACT: Twenty-eight patients undergoing major aortic reconstructions were prospectively randomized into two groups to compare blood replacement with either whole blood (WB) or packed cells (PRBC). Cardiac index (CI), pulmonary capillary wedge pressure (PCWP), intrapulmonary shunt (Qs/Qt), serum colloid osmotic pressure (COP), platelets, prothrombin time (PT), partial thromboplastin time (PTT), and fibrinogen were measured before operation, during operation, and for three days after operation. The postoperative CI increased significantly in both groups from preoperative value, but was not significantly different between the groups. In the PRBC group, there was a significant decrease in postoperative COP and COP-PCWP gradient from preoperative value. This did not occur in the WB group. There was no significant difference between groups in postoperative Qs/Qt, nor was there any evidence of clinical or radiographic pulmonary dysfunction. Both groups manifested a prolongation of the PT and PTT immediately after operation, but these returned to normal without intervention by the first day after operation. It is felt that blood replacement with reconstituted packed red cells can provide effective volume replacement without producing coagulopathy. The decreases observed in COP and COP-PCWP gradient do not result in physiologic or clinical evidence of significant pulmonary dysfunction.Annals of Surgery 04/1981; 193(3):337-40. DOI:10.1097/00000658-198103000-00015 · 7.19 Impact Factor