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Pump-induced platelet aggregation in albumin-coated extracorporeal systems Piet Borgdorff, PhD, Rogier H. van den Berg, MsC, Martijn A. Vis, PhD, Gerard C. van den Bos, MD, PhD, Geert Jan Tangelder, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 118, Issue 5, Pages 946-952 (November 1999) DOI: 10.1016/S0022-5223(99)70066-8 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Setup for in vitro experiments. Blood flow was generated either by gravity or by roller pump. Gravitational flow was maintained by servo-controlled up-and-down motion of open syringes at each tube end (arrows). For pump perfusion one tube end was disconnected from syringe and put in other syringe and pump was started after tightening its rollers. Platelet aggregation was continuously monitored in an albumin-coated glass capillary inserted in circuit and placed on microscope stage. Changes in light transmission from passage of aggregates were detected by photodiodes. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 946-952DOI: (10.1016/S0022-5223(99)70066-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 A, In vitro platelet aggregation during gravitational flow of rat blood in uncoated tube. Blood was added to system at time 0. B, Absence of platelet aggregation in vitro in albumin-coated tube during gravitational flow and occurrence of aggregation at start of pump perfusion (arrow). Upper tracing shows signals from device measuring passage of platelet aggregates, middle tracing shows quantitation of these signals in 30 seconds, and lower tracing shows flow in system. Note that gravitational flow is bidirectional and pump flow is unidirectional. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 946-952DOI: (10.1016/S0022-5223(99)70066-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 A, In vivo platelet aggregation in albumin-coated tube at start of pump perfusion (arrow). Pump flow was set equal to spontaneous flow. B, Inhibition of pump-induced platelet aggregation by ATA. Middle tracings show recorded signals, upper tracings show number of aggregates as percentage of value found after injection of 2 ng ADP into tubing, and lower tracings show aortic pressure. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 946-952DOI: (10.1016/S0022-5223(99)70066-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Occurrence of platelet aggregation during pump perfusion (arrows) in albumin-coated tube (filled diamonds) and its prevention with ATA (filled squares). Data points represent means; error bars represent SEM. A, Human blood in vitro (without ATA, n = 6; with ATA, n = 3). B, Rat blood in vitro (without ATA, n = 9; with ATA, n = 3). C, Rat blood in vivo (without ATA, n = 5; with ATA, n = 3). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 946-952DOI: (10.1016/S0022-5223(99)70066-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 5 Platelet loss with pump perfusion (filled squares) and without pump perfusion (filled diamonds) in albumin-coated tube in vitro. Data points represent means; error bars represent SEM. Asterisk indicates significant difference between concomitant time points of pump flow and gravitational flow. A, Human blood (with pump, n = 8; without pump, n = 3). B, Rat blood (with pump, n = 8; without pump, n = 7). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 946-952DOI: (10.1016/S0022-5223(99)70066-8) Copyright © 1999 Mosby, Inc. Terms and Conditions