How do we manage cardiopulmonary bypass coagulopathy?

Welsh, Kerry J.; Nedelcu, Elena; Bai, Yu; Wahed, Amer; Klein, Kimberly; Tint, Hlaing; Gregorič, Igor D.; Patel, Manish Kumar; Kar, Biswajit; Loyalka, Pranav; Nathan, Sriram; Loubser, Paul G.; Weeks, Phillip; Radovancevic, Rajko; Nguyen, Andy

doi:10.1111/trf.12751

Cited by 18 publications

(12 citation statements)

References 29 publications

(55 reference statements)

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“…[8] Patients in Steiner's study were classified either with severe uremia (BUN >102) or mild uremia (BUN < 102). [8] An additional study by Brophy et al, found a positive correlation between bleeding time and serum creatinine but no relationship with BUN. [9] Disagreement between studies is likely due to lack of standardization of platelet aggregometry from lab to lab since different concentrations are used for each of the agonists.…”

Section: Discussionmentioning

confidence: 99%

“…[8] Though not all inclusive, the majority of surgeries we perform bleeding risk assessments for include orthotopic heart transplants (OHTs), left ventricular assist devices (LVADs), and aortocoronary bypass (ACB). Quite often these patients have concomitant renal dysfunction with underlying heart disease.…”

Section: Introductionmentioning

confidence: 99%

“…At our institution, we routinely perform a pre-operative hemostatic risk assessment for most pre-op cardiac surgery patients as part of our Hemotherapy clinical service. 8 Although not all inclusive, the majority of surgeries we perform bleeding risk assessments for include orthotopic heart transplants (OHTs), left ventricular assist devices (LVADs) and aortocoronary bypass (ACB). Quite often these patients have concomitant renal dysfunction with underlying heart disease.…”

Section: Introductionmentioning

confidence: 99%

“…Steiner et al7 only found correlation between platelet aggregation by collagen to BUN/creatinine and bleeding time but no correlation with ADP or epinephrine. Patients in Steiner's study were classified either with severe uremia (BUN > 102) or mild uremia (BUN < 102) 8. An additional study by Brophy et al,9 found a positive correlation between bleeding time and serum creatinine but no relationship with BUN.…”

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confidence: 99%

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Platelet aggregometry cannot identify uremic platelet dysfunction in heart failure patients prior to cardiac surgery

Showalter¹,

Nguyen²,

Baba³

et al. 2016

J Clin Lab Anal

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INTRODUCTION Patients with heart failure often have concomitant renal disease which can result in uremic platelet dysfunction. Determining whether uremia has affected platelets by platelet aggregometry can be challenging in these patients since they are often on antiplatelet medications. The current study was undertaken to determine if platelet aggregation studies could identify heart failure patients at risk for uremic bleeding prior to cardiac surgery. MATERIALS AND METHODS Platelet aggregation studies from three groups were studied and compared: 17 heart failure patients with mild to moderate renal impairment, 17 heart failure patient without renal abnormalities, and 17 healthy volunteers. RESULTS Platelet aggregation was severely impaired in both heart failure groups with and without renal abnormalities compared to healthy controls, and there were no significant differences in platelet aggregation in response to any of the agonists. There was a pan-decrease in platelet aggregation to all agonists in all heart failure patients. CONCLUSION Platelet aggregometry does not appear to be useful in measuring platelet dysfunction in heart failure patients with mild to moderate renal impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Platelet aggregometry cannot identify uremic platelet dysfunction in heart failure patients prior to cardiac surgery

Showalter¹,

Nguyen²,

Baba³

et al. 2016

J Clin Lab Anal

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“…A new pathology clinical consultation service for laboratory support and transfusion management during major cardiac surgery resulted in decreased blood product use and reduction in surgical reoperation rates. 17 Other reports in the literature highlight improved outcomes and cost savings by pathology consultation. For example, pathology consultation for coagulation factor replacement for patients with hemophilia in a tertiary care center resulted in appropriate therapy and significant financial savings.…”

Section: Discussionmentioning

confidence: 99%

Algorithmic Approach With Clinical Pathology Consultation Improves Access to Specialty Care for Patients With Systemic Lupus Erythematosus

Chen¹,

Welsh²,

Chang³

et al. 2016

Am J Clin Pathol

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Objectives: Harris Health System (HHS) is a safety net system providing health care to the underserved of Harris County, Texas. There was a 6-month waiting period for a rheumatologist consult for patients with suspected systemic lupus erythematosus (SLE). The objective of the intervention was to improve access to specialty care.Methods: An algorithmic approach to testing for SLE was implemented initially through the HHS referral center. The algorithm was further offered as a "one-click" order for physicians, with automated reflex testing, interpretation, and case triaging by clinical pathology.Results: Data review revealed that prior to the intervention, 80% of patients did not have complete laboratory workups available at the first rheumatology visit. Implementation of algorithmic testing and triaging of referrals by pathologists resulted in decreasing the waiting time for a rheumatologist by 50%. Conclusions:Clinical pathology intervention and case triaging can improve access to care in a county health care system.The Harris Health System (HHS) is the safety net health care system for Harris County, Texas, which is the third largest county in the United States. This health care system consists of two hospitals, 23 community health centers, five school-based clinics, and several clinics that provide specialist care. The HHS provides access to care for many patients who would otherwise be unable to see a physician outside of an emergency department setting. However, this system is challenged by a shortage of clinic visit spots available for patients, especially for specialist care. For example, it was taking as long as 6 months for a patient to get an appointment with a rheumatologist in the HHS. Rheumatologic conditions such as systemic lupus erythematosus (SLE) necessitate prompt diagnosis and early treatment to avoid permanent end-organ damage.1 Thus, the prolonged waiting period to see a rheumatologist is anticipated to delay timely diagnosis, postpone initiation of therapy, and cause dissatisfaction for both patients and theirUpon completion of this activity you will be able to:• identify how a clinical pathology consultation service can improve access to specialty care in a resource limited setting.• describe the benefits of automated reflex testing.• understand the importance of value-based health care.The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit TM per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module.The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.Exam is located at www.ascp.org/ajcpcme. CME/SAM

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Practical Issues in POCT

Agostini

2015

Point-of-Care Tests for Severe Hemorrhage

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How do we manage cardiopulmonary bypass coagulopathy?

Abstract: We described the successful introduction of a novel pathology consultation service that uses a rapid TAT coagulation testing menu with transfusion algorithms for improved management of CPB patients.

Cited by 18 publications

References 29 publications

Platelet aggregometry cannot identify uremic platelet dysfunction in heart failure patients prior to cardiac surgery

Platelet aggregometry cannot identify uremic platelet dysfunction in heart failure patients prior to cardiac surgery

Algorithmic Approach With Clinical Pathology Consultation Improves Access to Specialty Care for Patients With Systemic Lupus Erythematosus

Practical Issues in POCT

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