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It is a well-known fact that free-Hb induces many postoperative complications, especially during open heart surgery for extracorporal circulation. Currently, measurement of serum free-Hb determines the degree of hemolysis. Also measurements of serum haptoglobin (Hp) and hemopexin (Hx) are usefull to determin degree of hemolysis.The purpose of the present study was to investigate the degree of hemolysis by measurements of Hp, Hx, LDH, GOT, GPT and ALP from pre-anesthesia to 2nd postoperative day.The patients were divided into three groups: Group A-12 patients underwent open heart surgery for extracorporal circulation; Group B-17 patients underwent open heart surgery and were given about 360ml of Single Donor Plasma Fresh Frozen; Group C-28 patients performed general surgery. Hp and Hx were measured with the use of Hoechst M—Partigen and LDH, GOT, GPT and ALP were measured with the use of LKB8600. In A and B group, the blood was taken at pre-anesthesia, pre-bypass, during-bypass, post-operation, 1st postoperative day and 2nd day. In the case of C group, the blood was taken at pre-anesthesia, during-operation, post-operation, 1st postoperative day and 2nd day.The serum level of Hp in A group was 136±20mg/dl (mean±SE) at pre-anesthesia, 89±11mg/dl during bypass, 101±12mg/dl at post-bypass, 108±20mg/dl at postoperation. These concentrations were within normal limits. However Hp of 1st day was 14±3mg/dl that reduced markedly at about 90% as compared with pre-anesthesia. At 2nd day, Hp was 49±10mg/dl that restored but was still low concentration. In the case of B group, although the Plasma Fresh Frozen which contained about 500mg of Hp transfused within 3 hours after operation, the serum level of Hp at 1st day was 22±5mg/dl that was similar to A group and revealed at about 90% reduction. At the 2nd day, Hp was 46±11mg/dl. In C group, the level of Hp slightly reduced during operation and also at 1st day. But at the 2nd day, the level of Hp elevated about 17% as compared with preanesthetic concentration.The serum levels of LDH and GOT in A group were almost similar to those in B group. The fructuation of LDH and GOT were within normal limits from pre-anesthesia to during-bypass but increased after post-bypass. The peak concentration occurred at 1st day. GPT and ALP in three groups were within normal limits.The serum level of Hp was well-maintained during operation because our priming for extracorporal circuit included 5 units of Plasma Fresh Frozen. However at 1st postoperative day, Hp reduced markedly and also LDH and GOT increased strikingly. These findings are suggestive of continued hemolysis after operation, especially at 1st postoperative day. It is considered that the Hp must be administrated at 1st postoperative day rather than during operation and also the administration of purifized Hp rather than Plasma Fresh Frozen may be effective.
- 一般社団法人 日本輸血・細胞治療学会の論文
一般社団法人 日本輸血・細胞治療学会 | 論文
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