INTRAOPERATIVE REINFUSION OF AUTOERYTHROCYTES AND RED BLOOD CELL MORPHOFUNCTIONAL PARAMETERS IN WOMEN AT MYOMECTOMY

Objective. To evaluate the impact of intraoperative reinfusion of autoerythrocytes (IRA) on the morphological state of peripheral red blood cells in patients at myomectomy. Subject and methods. A study group consisted of 179 patients operated on for multiple myoma (myomectomy and hysterectomy). IRA was carried out using a Autotransfusion System (ATS) in 94 patients (a study group). Donor red blood cells were transfused in 85 patients (a comparative group). Blood loss averaged 1012.6±511.3 ml. In Group 1, the volume of reinfused autoerythrocytes averaged 579.3±227.4 ml. In Group 2, that of allogeneic blood averaged 598.9±198.4 ml. A control group included 20 healthy female blood donors. The morphological parameters of peripheral red blood cells were examined using intravital blood cell computed phasometry (CPM). Microelectrophoresis (MEP) was used to evaluate the electrokinetic properties of red blood cells. Results. Preoperatively, the peripheral blood of patients with uterine myoma showed increases in the mean diameter, perimeter, and area of circulating red blood cells with a reduction in the mean phasic cell height. Analysis of the morphological structure of red blood cells from healthy donors indicated that the content of diskocytes, echinocytes, and spherocytes amounted to 73.5, 16.1, and 10.4 %, respectively. In the uterine myoma group, the ratio of the morphological cell types was different: 63.9, 19.5, and 16.6%, respectively. In this group, the ratio of the number of all transformed red blood cells to the absolute number of diskocytes (transformation index) was much higher (0.56) than that in the healthy donors (0.36), which quantitatively characterizes poikylocytosis. Analysis of the electrokinetic properties of red blood cells revealed that the patients had preoperatively the mean count of treatment-suitable cells of as many as 165.87±72.65; the mean fluctuation amplitude for red blood cells was 5.62±1.78 μm; the proportion of immobile red blood cells was 29.21±7.92%. Postoperatively, the patients undergoing IRA were found to have better electrokinetic parameters of peripheral red blood cells: the treatment-suitable cells increased and accounted for 331.25±98.0; the mean fluctuation amplitude for red blood cells was 6.12±3.46 μm; the proportion of immobile red blood cells was 36.23±6.92%. In Group 2 patients, the parameters were significantly lower: the treatment-suitable cells increased and amounted to 229.33±12.4; the mean fluctuation amplitude for red blood cells was only 4.66±0.99 μm; the proportion of immobile red blood cells was 46.62±8.81%. Conclusion. The findings suggest that IRA is effective and should be used at myomectomy, which ensures rapid stabilization in the morphometric and electrokinetic properties of circulating red blood cells unlike in those obtained at transfusion of donor red blood cells. Transfusion of autoerythrocytes contributes to the recovery of blood rheological properties in patients.

intraoperative reinfusion of autoerythrocytes, uterine myoma, myomectomy, morphological and electrokinetic properties of red blood cells, safety and efficiency