[The relationship of AB0- and rhesus-phenotypes of erythrocytes with expression of intra-operational hemolysis in cardio-surgical patients].

The study sampling included patients with ischemic heart disease with mild (70 patients) and marked (36 patients) hemolysis after coronary artery bypass grafting under artificial blood circulation. During post-operation period the content of free hemoglobin in blood plasma, AB0- and rhesus-phenotype of erythrocytes were evaluated. It is established that in patients with marked intra-operational hemolysis as compared with cases of mild hemolysis the phenotypes of erythrocytes B(III), AB(IV), ccDEE, ccDEe are found reliably more often and 0(I)-phenotype is found reliably more rare. The risk factor of marked intra-operational hemolysis is a verification of ccD(E/e)-phenotype of erythrocytes and in case of different rhesus-phenotypes--blood type B(III) or AB(IV).

[Characteristic of the complement system in patients with ischemic heart disease with moderate and marked hemolysis after operations with cardiopulmonary bypass].

A study of the complement system in cardiosurgical patients with moderate (40 patients) and marked (18 patients) hemolysis after coronary artery bypass grafting in conditions of cardiopulmonary bypass was carried out. Before and after operation the content of D35+-, D55+-erythrocytes and reticulocytes in blood, free hemoglobin in blood plasma, indicators of the functional state of classical, lectin and alternative pathways of complement activation as well as concentration of its terminal complex in blood serum were analyzed. It was established that development of marked hemolysis was associated with higher (compared with moderate hemolysis) content of terminal complement complex and reticulocytes in blood before operation as well as deficiency of D55+- erythrocytes and low activity of alternative pathway.

[Factors of intravascular hemolysis in cardiosurgical patients after cardiopulmonary bypass procedures].

The study included patients with ischemic heart disease with moderate (52 patients) and apparent (23 patients) hemolysis after coronary bypass surgery in cardiopulmonary bypass (CB). The concentration of free hemoglobin in blood plasma, mechanical resistance and sorption capacity of red cells as well as the content of TBA-active products, cholesterol and phospholipids in red cells and reticulocytes levels in blood were studied before and after operation. It was shown that among patients with apparent post-perfusion hemolysis (in contrast to the patients with a moderate hemolysis) the sorption capacity of red cells and amount of reticulocytes in blood are increased before operation; level of TBA-active products in erythrocytes is increasing after operation. Development of moderate hemolysis is associated with the decreased mechanical resistance of erythrocytes and increased cholesterol/phospholipid-ratio in membranes before operation. Thus, individually-specified apparent post-perfusion hemolysis is based on free-radical mechanism of erythrocytes damage and moderate hemoglobin level is referred to mechanical trauma of blood cells during CB.

[The pathogenesis factors of intraoperative hemolysis in cardiac surgery].

As shown in various studies, hemolysis is revealed in all extracorporeal circuits showing the increasing levels of plasma-free hemoglobin (PfHb) during and after cardiopulmonary bypass (CPB). The pathogenesis factors and mechanisms of intraoperative hemolysis are observed in this article. The role of mechanical blood trauma, oxygen free radical generation, activation of complement, preoperative defects erythrocytes, infusion preparations and other medicaments in postperfusion hemolysis are discussed. Along with the complete red blood cell (RBC) destruction (hemolysis), RBCs can also be damaged on a sublethal level, resulting in altered rheological properties, decreased microcirculation and organ dysfunction caused by hypoxia. The severity of the consequences of RBC damage, the high incidence of this complication and the lack of interventional strategies in cases of suspected or confirmed RBC damage are considered, there may be a need for a treatment algorithm for this phenomenon.

[The interconnection between cytokines and the factors of bactericidal action of neutrophiles in patients operated on under the conditions of cardiopulmonary bypass].

The use of cardiopulmonary bypass (CPB) is associated with the development of a system inflammatory response. The subjects of the study were 48 patients with coronary heart disease (CHD), operated on under the condition of CPB. The following parameters were measured: the content of cation proteins and active oxygen forms in neutrophiles, the digesting capacity of these cells, and the serum levels of interleukins (IL)-1beta, 1ra, -4, -6, -8, and tumor necrosis factor-alpha (TNF-alpha). The measurements were made before performing coronary bypass surgery, and also 6 and 24 hours after surgery. The results showed that the levels of cytokines and the bactericidal activity of neutrophiles were elevated in CHD patients before surgery. The changes after surgery included an increased macrophageal digesting capacity with switching to oxygen-independent mechanisms, as well as increased levels of TNF-alpha, IL-1ra, and IL-1ra:IL-1beta. The changes were more prominent 6 hours after surgery. Oxygen-dependent killing was controlled mostly by IL-6 during the pre-operative period, and by this plus TNF-alpha 24 hours after surgery. The content of cation proteins in neutrophiles before surgery correlated with the concentrations of TNF-alpha and IL-8. These interconnections weakened 6 hours after surgery and became stronger 24 hours after it.