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Does adding albumin to the prime solution of a circuit with a Trillium Biopassive Surface-coated oxygenator benefit platelets? / Harry Legaspi.

by Legaspi, Harry.

Extracorporeal Circulation -- instrumentation

Coated Materials, Biocompatible

Hemostasis, Surgical

Blood Coagulation.

65 leaves : ill. ; 29 cm.

Thesis advisor: Dr. Ron Gerrits.

Committee members: Dr. Larry Fennigkoh, Shannon Voborsky.

Introduction and background -- Experimental design and statistical methods -- Results, discussion, conclusion, and recommendations -- A: Platelet receptors and agonists -- B: Raw data -- C: Statistical output.

Cardiopulmonary bypass (CPB) activates blood to such an extent that hemostatic derangements are common in the post-operative setting. A significant amount of activation occurs because of blood-biomaterial interactions. In particular, many platelets become activated through interactions with surface-adsorbed fibrinogen. Because platelets are vital contributors to hemostasis, preserving them through mechanisms that decrease their activation may be beneficial to patients. Two common ways of reducing platelet and blood activation are to use circuits with proprietor-developed surface coatings or prime the circuit with an albumin-containing solution. Although many studies assess the individual contributions of albumin priming and surface coatings on platelet preservation, few studies have evaluated whether utilizing both methods results in greater preservation than either method alone. This study seeks to determine whether platelet preservation is enhanced if an in vitro circuit containing a coated oxygenator is albumin primed.

Trillium Biopassive Surface-coated Affinity oxygenators (Medtronic, Minneapolis, MN) (n=10) were separated into three treatment groups based on the level of albumin pre-treatment (albumin priming). Group 1 was the control and received no albumin pre-treatment, group 2 received a low concentration of albumin (0.0375 grams albumin per 100 cm3 prime), and group 3 received a high concentration of albumin (0.125 grams per 100 cm3 prime). A simple circuit consisting of an Affinity oxygenator with an integrated cardiotomy/venous reservoir and pump head was used. These circuits were primed with an isotonic solution and the appropriate amount of albumin. Bovine blood was added to the circuit after this solution had circulated for 20 minutes. Platelet count and function was analyzed using a platelet function analyzer (Plateletworks Whole Blood Aggregation and CBC Testing Device, Helena Laboratories, Beaumont, TX) prior to trial initiation (baseline), then at 5, 15, and 60 minutes trial initiation.

The platelet count of the control group was less than the albumin groups (p<0.001 between control and both pre-treated albumin groups). However, this result does not indicate that the albumin preserved platelet count because all three groups showed a similar platelet count drop for the duration of the experiment (p=0.38). Platelet function, assessed by collagen aggregometry, indicated that the percentage of platelet aggregation of the control group was higher than the albumin groups (p<0.02 between the control group and both albumin pre-treatment groups). The percentage of platelet aggregation did not decrease during the duration of the experiment (p=0.06).

Albumin priming resulted in no difference in platelet count at any time interval measured in this study. The data do not show that albumin-primed circuits containing an oxygenator coated with the Trillium Biopassive Surface preserves platelet function compared to a similar circuit that is not albumin primed. Future studies should use a more precise platelet activation test, such as light transmission aggregometry, or immunoassay testing for markers of platelet activiation.

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