Mannitol-adenine-phosphate: a novel solution for intraoperative blood salvage.

BACKGROUND: Intraoperative blood salvage (IBS) procedures include washing with normal saline (NS), which may deplete red blood cell (RBC) nutrients. The mannitol-adenine-phosphate (MAP) solution, commonly used for RBC preservation, provides glycolytic substrates; therefore, MAP should be a better solution than NS in IBS. In this study, we determined whether using MAP could reduce washing-associated RBC damage and destruction. STUDY DESIGN AND METHODS: Adenine nucleotide contents, RBC morphology, and plasma free hemoglobin (PF-Hb) level of RBCs treated with NS or MAP solution were compared under three conditions: (1) 4-hour preservation of fresh blood from healthy volunteers, (2) collection from the shed blood of patients, and 3) incubation of the collected shed blood with plasma. RESULTS: Adenine nucleotide level and RBC elongation index were greater and PF-Hb level was lower in MAP groups than NS groups (p < 0.05) after preservation and incubation. In NS, RBCs lost their deformability and became stomatocytes, and even RBC "ghosts" 48 hours after incubation, while they remained normal in MAP solution. CONCLUSION: The MAP solution helps preserve RBC morphology and function, and reduces hemolysis, possibly due to improved energy production. Therefore, MAP should replace NS during IBS.

The use of mannitol in intracerebral bleeds in the medical ICU.

To determine the effects of mannitol osmotherapy, we reviewed patients admitted to the intensive care unit with a presumptive diagnosis of increased intracranial pressure. The conclusion from our 20-patient study revealed no significant therapeutic benefit using mannitol osmotherapy.