The catecholamine concentrations of collected autologous blood during adrenalectomy for pheochromocytoma

We studied the catecholamine concentrations in collected autologous blood of a patient undergoing adrenalectomy for pheochromocytoma. In the preoperative laboratory data, plasma concentrations (normal ranges) of epinephrine, norepinephrine and dopamine were 60180 pg · ml^-1 (<100), 11090 pg · ml^-1 (100 ~ 450) and 104 pg · ml^-1 (<20), respectively. The catecholamine levels of collected blood were epinephrine 2490000 pg · ml^-1, norepinephrine 352300 pg · ml^-1 and dopamine 6100 pg · ml^-1 before wash. Wash of collected blood with 1000 ml saline diluted the catecholamines to epinephrine 212000 pg · ml^-1, norepinephrine 18700 pg · ml^{- 1} and dopamine 4900 pg · ml^-1. Platelet activation by contact with tissue collagen or thrombin results in the release of catecholamine concentrated in the dense body. The mechanical stimulation by suction, roller pump and centrifugation during blood collection may accelerate the catecholamine release from platelets. Thus, saline wash hardly reduces catecholamine concentrations of collected blood from a patient with pheochromocytoma. In this particular case, plasma catecholamines seem to exceed the potential capacity of platelets in amount. The dilution effect for epinephrine and norepinephrine probably reflects the washout of greater amount of plasma catecholamines. However, saline wash was unable to reduce catecholamines contained in the collected blood to a safe level, and hypertension following autotransfusion was predictable. We conclude that hemodynamic change should be monitored carefully during intraoperative autotransfusion in a case of pheochromocytoma.