PMID- 35846208
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230916
IS  - 2688-6146 (Electronic)
IS  - 2688-6146 (Linking)
VI  - 3
IP  - 1
DP  - 2022 Feb
TI  - Complement activation during cardiopulmonary bypass and association with clinical 
      outcomes.
PG  - 86-96
LID - 10.1002/jha2.371 [doi]
AB  - In this prospective, single-centre observational study of 30 patients undergoing 
      cardiopulmonary bypass (CPB), the effect of unfractionated heparin (UFH), CPB 
      surgery and protamine sulphate on complement and on post-operative blood loss 
      were assessed. Although C3 and C4 levels decreased significantly immediately 
      following the administration of UFH, C3a, C5a, Bb fragment and SC5b-9 remained 
      unchanged. During CPB, C3 and C4 continued to fall whilst both alternative and 
      classical pathways activation markers, Bb, C3a, C5a and SC5b-9 increased 
      significantly. Protamine sulphate had no effect on classical pathway components 
      or activation markers but decreased alternative pathway activation marker Bb. 
      Over the 12-24 h post-surgery, both classical and alternative pathway activation 
      markers returned to baseline, whilst C3 and C4 levels increased significantly but 
      not to baseline values. Total drain volume 24 h after the surgery showed a 
      moderate inverse correlation with post-protamine C3 (r = -0.46, p = 0.01) and C4 
      (r = -0.57, p = 0.0009) levels, whilst a moderate positive correlation was 
      observed with post-protamine C3a (r = 0.46, p = 0.009), C5a (r = 0.37, p = 0.04) 
      and SC5b-9 (r = 0.56, p = 0.001) levels but not with Bb fragment (r = 0.25, 
      p = 0.17). Thus, inhibition of complement activation may be a therapeutic 
      intervention to reduce post-operative blood in patients undergoing CPB.
CI  - (c) 2022 The Authors. eJHaem published by British Society for Haematology and John 
      Wiley & Sons Ltd.
FAU - Kefalogianni, Rengina
AU  - Kefalogianni R
AD  - Department of Immunology and Inflammation Imperial College London London UK.
FAU - Kamani, Farah
AU  - Kamani F
AD  - Department of Haematology Royal Brompton Hospital London UK.
FAU - Gaspar, Mihaela
AU  - Gaspar M
AD  - Department of Haematology Royal Brompton Hospital London UK.
FAU - Aw, T C
AU  - Aw TC
AD  - Department of Anesthesia and Critical Care Royal Brompton Hospital London UK.
FAU - Donovan, Jackie
AU  - Donovan J
AD  - Department of Biochemistry Royal Brompton Hospital London UK.
FAU - Laffan, Mike
AU  - Laffan M
AUID- ORCID: 0000-0002-8268-3268
AD  - Centre for Haematology Department of Immunology and Inflammation Imperial College 
      London London UK.
FAU - Pickering, Matthew C
AU  - Pickering MC
AD  - Department of Immunology and Inflammation Imperial College London London UK.
FAU - Arachchillage, Deepa J
AU  - Arachchillage DJ
AUID- ORCID: 0000-0001-5993-4850
AD  - Department of Haematology Royal Brompton Hospital London UK.
AD  - Centre for Haematology Department of Immunology and Inflammation Imperial College 
      London London UK.
LA  - eng
GR  - MR/V037633/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
DEP - 20220113
PL  - United States
TA  - EJHaem
JT  - EJHaem
JID - 101761942
PMC - PMC9175769
OTO - NOTNLM
OT  - anaphylatoxins
OT  - bleeding
OT  - cardiopulmonary bypass
OT  - complement
OT  - heparin
OT  - protamine sulphate
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/07/19 06:00
MHDA- 2022/07/19 06:01
PMCR- 2022/01/13
CRDT- 2022/07/18 03:59
PHST- 2021/11/04 00:00 [received]
PHST- 2021/12/02 00:00 [revised]
PHST- 2021/12/07 00:00 [accepted]
PHST- 2022/07/18 03:59 [entrez]
PHST- 2022/07/19 06:00 [pubmed]
PHST- 2022/07/19 06:01 [medline]
PHST- 2022/01/13 00:00 [pmc-release]
AID - JHA2371 [pii]
AID - 10.1002/jha2.371 [doi]
PST - epublish
SO  - EJHaem. 2022 Jan 13;3(1):86-96. doi: 10.1002/jha2.371. eCollection 2022 Feb.