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Cardiopulmonary bypass induces significant platelet activation in children undergoing open-heart surgery

Published online by Cambridge University Press:  28 January 2005

J. Guay ,
P. Ruest  and
L. Lortie
J. Guay
Affiliation:
University of Montreal, Maisonneuve-Rosemont Hospital, Department of Anesthesia, Montreal, Canada
P. Ruest
Affiliation:
University of Montreal, Ste-Justine Hospital, Department of Anesthesia, Montreal, Canada
L. Lortie
Affiliation:
University of Montreal, Ste-Justine Hospital, Department of Anesthesia, Montreal, Canada
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Extract

Summary

Background and objectives: To evaluate the effects of cardiopulmonary bypass (CPB) on platelet function in children undergoing open-heart surgery.

Methods: Data from 16 consecutive children undergoing cardiac surgery with CPB were prospectively collected. Blood samples of 10 mL were collected via the central venous line immediately before and after CPB for CD62 measurements by flow cytometry.

Results: Ten children had acyanotic heart disease (median age 3 yr, range 1.8–14) and six had a cyanotic defect (median age 4 yr, range 2–14). The platelet count decreased significantly with CPB in both groups: from 163.5 (130–201) to 93.5 (57–186) × 103 μL−1 in acyanotic children and from 139.5 (77–212) to 75 (43–99) × 103 μL−1 in cyanotic children (P < 0.0001). The percentage of activated platelets was significantly lower in acyanotic children at baseline: 1% (0–23%) vs. 5% (3–8%) (P = 0.07). CPB increased the percentage of activated platelets significantly in both groups: post-bypass the values were 10% (range 1–17%) in acyanotic children and 7% (range 1–30%) in cyanotic children (P = 0.03). The increase in the percentage of activated platelets did not differ between the two study groups (P = 0.11).

Conclusion: CPB induces significant platelet activation in children undergoing open-heart surgery.

Keywords

BLOOD LOSS, surgicalPLATELET ACTIVATIONP-SELECTIN, CD62FLOW CYTOMETRYHEART DEFECT, congenitalCARDIAC SURGICAL PROCEDURECARDIOPULMONARY BYPASS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 12 , December 2004 , pp. 953 - 956
Copyright
© 2004 European Society of Anaesthesiology

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References

Williams GD, Bratton SL, Riley EC, Ramamoorthy C. Association between age and blood loss in children undergoing heart operations. Ann Thorac Surg 1998; 66: 870–876.Google Scholar
Guay J, Rivard G-E. Mediastinal bleeding after cardiopulmonary bypass in pediatric patients. Ann Thorac Surg 1996; 62: 1955–1960.Google Scholar
Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the full-term infant. Blood 1987; 70: 165–172.Google Scholar
Kern FH, Morana NJ, Sears JJ, Hickey PR. Coagulation defects in neonates during cardiopulmonary bypass. Ann Thorac Surg 1992; 54: 541–546.Google Scholar
Boldt J, Knothe C, Zickmann B, Wege N, Dapper F, Hempelmann G. Aprotinin in pediatric cardiac operations: platelet function, blood loss, and use of homologous blood. Ann Thorac Surg 1993; 55: 1460–1466.Google Scholar
Mauer HM, McCue CM, Caul J, Still WJ. Impairment in platelet aggregation in congenital heart disease. Blood 1972; 40: 207–216.Google Scholar
Gross S, Keefer V, Liebman J. The platelets in cyanotic congenital heart disease. Pediatrics 1968; 42: 651–658.Google Scholar
Gill JC, Wilson AD, Endres-Brooks J, Montgomery RR. Loss of the largest von Willebrand factor multimers from the plasma of patients with congenital cardiac defects. Blood 1986; 67: 758–761.Google Scholar
Miller BE, Mochizuki T, Levy JH, et al. Predicting and treating coagulopathies after cardiopulmonary bypass in children. Anesth Analg 1997; 85: 1196–1202.Google Scholar
Manno CS, Hedberg KW, Kim HC, et al. Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children. Blood 1991; 77: 930–936.Google Scholar
Seear MD, Wadsworth LD, Rogers PC, Sheps S, Ashmore PG. The effect of desmopressin acetate (DDAVP) on postoperative blood loss after cardiac operations in children. J Thorac Cardiovasc Surg 1989; 98: 217–219.Google Scholar
Williams GD, Bratton SL, Ramamoorthy C. Factors associated with blood loss and blood product transfusions: a multivariate analysis in children after open-heart surgery. Anesth Analg 1999; 89: 57–64.Google Scholar
Williams GD, Bratton SL, Riley E, Ramamoorthy C. Coagulation tests during cardiopulmonary bypass correlate with blood loss in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1999; 13: 398–404.Google Scholar
Williams GD, Bratton SL, Nielsen NJ, Ramamoorthy C. Fibrinolysis in pediatric patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1998; 12: 633–638.Google Scholar
Forestier F, Coiffic A, Mouton C, Ekouevi D, Chene G, Janvier G. Platelet function point-of-care tests in post-bypass cardiac surgery: are they relevant? Br J Anaesth 2002; 89: 715–721.Google Scholar
Harrison P, Cramer EM. Platelet alpha-granules. Blood Rev 1993; 7: 52–62.Google Scholar
Metzelaar MJ, Korteweg J, Sixma JJ, Nieuwenhuis HK. Comparison of platelet membrane markers for the detection of platelet activation in vitro and during platelet storage and cardiopulmonary bypass surgery. J Lab Clin Med 1993; 121: 579–587.Google Scholar
de Haan J, van Oeveren W. Platelets and soluble fibrin promote plasminogen activation causing downregulation of platelet glycoprotein Ib/IX complexes: protection by aprotinin. Thromb Res 1998; 92: 171–179.Google Scholar
Chew MS, Brandslund I, Brix-Christensen V, et al. Tissue injury and the inflammatory response to pediatric cardiac surgery with cardiopulmonary bypass. Anesthesiology 2001; 94: 745–753.Google Scholar
Levin E, Wu J, Devine DV, et al. Hemostatic parameters and platelet activation marker expression in cyanotic and acyanotic pediatric patients undergoing cardiac surgery in the presence of tranexamic acid. Thromb Haemost 2000; 83: 54–59.Google Scholar
Komp DM, Sparrow AW. Polycythemia in cyanotic heart disease – a study of altered coagulation. J Pediatr 1970; 76: 231–236.Google Scholar
Wedemeyer AL, Castañeda AR, Edson JR, Krivit W. Serial coagulation studies in patients undergoing Mustard procedure. Ann Thorac Surg 1973; 15: 120–127.Google Scholar