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June 20, 1990

The Use of Autologous Blood-Reply

Author Affiliations

National Heart, Lung, and Blood Institute Bethesda, Md

National Heart, Lung, and Blood Institute Bethesda, Md

JAMA. 1990;263(23):3151. doi:10.1001/jama.1990.03440230046026

In Reply.—  Drs Bull and Bull hypothesize that platelet activation by the plastic bowl during washing of diluted human blood causes the rare phenomenon of anasarca, adult respiratory distress syndrome, and disseminated intravascular coagulation. Evidence for this hypothesis includes (1) their observation that platelet deposits can form and (2) the observation that, in dogs, reinfusion of washed red blood cells prepared in bowls coated with such platelet layers caused massive hemorrhage and increased vascular permeability. Evidence against this hypothesis includes the following: (1) The human cases of abnormal bleeding they describe may be due to other causes, such as dilutional coagulopathy or activation of complement by vascular grafts.1 (2) In their dog model, 40-μm filters were used, whereas in humans 20-μm filters that would remove platelet aggregates are used. (3) Platelets washed with saline in a cell washer without red blood cells can be transfused without the adverse effects