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The Journal of Cardiovascular Surgery 1999 October;40(5):653-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Red blood cell energy metabolism during cardiopulmonary bypass

Cavaliere F., Meo F., Scapigliati A., Sciarra M., Schiavello R.

From the Department of Anesthesiology and Resuscitation Catholic University of the Sacred Heart, Rome, Italy


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Background. During car­di­o­pul­mo­na­ry ­bypass (CPB) an intra­cel­lu­lar ATP def­i­cit ­could theo­ret­i­cal­ly ­play a ­role in chang­es of eryth­ro­cyte ­shape and deform­abil­ity ­caused by mechan­i­cal trau­ma. We there­fore stud­ied eryth­ro­cyte ener­gy metab­olism in 12 ­patients under­go­ing nor­mo­ther­mic CPB for myo­car­dial revas­cu­lar­iza­tion.
Methods. Blood sam­ples ­were col­lect­ed ­prior to and 45 min­utes ­after CPB begin­ning and ana­lyzed for eryth­ro­cyte ATP, ADP, and AMP and ­their metab­olites, eryth­ro­cyte NAD and ­NADP, plas­ma and ­whole ­blood lac­tate (Lactp and Lactb respec­tive­ly), and ­whole ­blood pyru­vate (Pyrb).
Results. Values ­were ­expressed as ­mean±stan­dard devi­a­tion or ­median (low­er and high­er quar­tiles) on the ­ground of a ­test for nor­mal­ity. During CPB eryth­ro­cyte nucle­o­tides and ­their metab­olites did not ­change sig­nif­i­cant­ly (ATP: 60.2±12.1 vs 68.3±13.0; ADP: 12.2±3.6 vs 12.0±3.1; AMP: 0.43±24 vs 0.44±0.26; aden­o­sine: 0.063 (0.034-0.203) vs 0.77 (0.032-0.221); ­inosine: 0.064 (0.023-0.072) vs 0.075 (0.025-0.111); hypox­an­thine: 0.330±0.272 vs 0.367±0.223; xan­thine: 0.193±0.090 vs 0.220±0.095; NAD: 3.149±0.743 vs 3.358±0.851; val­ues in µM/mM ­packed red ­blood ­cell hemo­glo­bin) ­while ­NADP ­increased (2.110±0.390 vs 2.433±0.288 µM/mM ­packed red ­blood ­cell hemo­glo­bin; p<0.05). Ringer lactate, ­with ­which the extra­cor­po­real cir­cuit was ­primed, ­caused Lactp to ­increase (1.87±0.81 vs 3.27±1.15 mM/l; p<0.01). Some lac­tate ­entered eryth­roc­y­tes ­since Lactp/Lactb ­ratio did not ­change (1.09±0.25 vs 1.07±0.23) and ­some was trans­formed ­into pyru­vate ­since Pyrb ­increased [62.9 (30.3-73.3) vs 100.5 (61.0-146.9) µM/l; p<0.01]. Lactb/Pyrb ­ratio did not ­change sig­nif­i­cant­ly [22.6 (16.1-40.5) vs 27.9 (17.5-35.2)] so ­that NAD/­NADH ­ratio and, con­se­quent­ly, the ­rate of gly­col­y­sis ­were unlike­ly to ­change too.
Conclusions. Erythrocyte ener­gy metab­olism is not affect­ed by CPB, at ­least dur­ing the peri­od of ­time tak­en ­into ­account in ­this ­study.

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