Incidence of Platelet Dysfunction by Thromboelastography–Platelet Mapping in Children Supported with ECMO: A Pilot Retrospective Study

Saini, Arun; Hartman, Mary E.; Gage, Brian F.; Said, Ahmed; Gazit, Avihu Z.; Eghtesady, Pirooz; Boston, Umar S.; Spinella, Philip C.

doi:10.3389/fped.2015.00116

Cited by 46 publications

(39 citation statements)

References 36 publications

(43 reference statements)

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“…Spontaneous platelet activation due to the patient's extreme hypercoagulability and/or conditions of blood‐sampling (through central arterial lines) might explain this tracing. Likewise, severe qualitative platelet dysfunction was reported with ADP TEG‐PM in children supported with ECMO, but in that study no information was given on MA fibrin tracings.…”

Section: Discussionmentioning

confidence: 89%

Platelet‐mapping assay for monitoring antiplatelet therapy during mechanical circulatory support in children: A retrospective observational study

Giorni¹,

Costopoulos

Bachelot‐Loza

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Thromboelastography (TEG)‐platelet mapping (PM) assay is used for antiplatelet‐drug monitoring.The TEG‐PM was evaluated for dypiridamole and aspirin monitoring in 4 BH‐implanted children.Some TEG‐PM tracings were atypical leading to wrong results.The TEG‐PM has to be improved for antiplatelet‐drug monitoring during ventricular assistance. IntroductionThe complex hemostatic changes associated with Berlin Heart (BH) implantation in children require a challenging antithrombotic treatment. The aim of this retrospective analysis was to evaluate the thromboelastography (TEG)‐platelet mapping (PM) assay to monitor antiplatelet therapy in children implanted with a BH.Methods TEG‐PM was performed in 4 BH‐implanted patients receiving dipyridamole and aspirin, and 9 healthy volunteers. Patients’ antiplatelet therapy was adjusted to TEG‐PM results. Light transmission aggregometry (LTA) was also available for 2 of these patients.ResultsBetween 2009 and 2014, 4 BH‐implanted patients received a dual antiplatelet therapy monitored by TEG‐PM. In 2 patients, 18 of 34 tracings were atypical, because the maximum amplitude due to fibrin never stabilized, which made difficult antiplatelet therapy adjustment as recommended by BH's guidelines. To overcome this difficulty, TEG‐PM and LTA were next performed in parallel. However, both methods led to different decisions to adjust antiplatelet therapy in 57% of the cases. In order to better understand this atypical tracing, TEG‐PM was also performed in 9 volunteers and surprisingly 3 of them had the same atypical tracing. This atypical tracing was corrected by adding apyrase, suggesting that adenosine diphosphate (ADP) participates to spontaneous platelet activation in heparinized samples. In addition, we evidenced a high variability in the responses of TEG‐PM with ADP in volunteers.ConclusionsAntiplatelet therapy monitoring in BH‐implanted children remains challenging, as TEG‐PM is sensitive to several preanalytical and analytical conditions.

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Section: Discussionmentioning

confidence: 89%

Platelet‐mapping assay for monitoring antiplatelet therapy during mechanical circulatory support in children: A retrospective observational study

Giorni¹,

Costopoulos

Bachelot‐Loza

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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“…There have been few pediatric studies of thromboelastography. Saini et al demonstrated severe platelet dysfunction in patients on extracorporeal membrane oxygenation (3). In a retrospective review of 150 children with congenital heart disease requiring cardiopulmonary bypass, Kane et al demonstrated a reduction in platelet and cryoprecipitate transfusions when intraoperative TEG was used to guide transfusion (12).…”

Section: Discussionmentioning

confidence: 99%

TEG Platelet Mapping and Impedance Aggregometry to Predict Platelet Transfusion During Cardiopulmonary Bypass in Pediatric Patients

et al. 2019

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Conclusions: TEG-PM ADP may provide more clinically relevant information regarding platelet function compared to the MEIA at the ADP receptor in children requiring cardiopulmonary bypass. There was limited correlation between TEG-PM and MEIA results which raises a concern about the accuracy of these tests at the ADP receptor. Lower pre-operative TEG-PM ADP MA may predict intra-operative platelet transfusions; however, larger studies are needed to determine the utility of TEG-PM and MEIA in guiding platelet transfusions in this population.

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“…7,8 Therefore, platelet transfusion has limited efficacy as the transfused platelets quickly become dysfunctional. Certain drugs 9,10 and procedures 11,12 that can affect platelet function need to be considered in these complicated patients (Table 1), but removal of the paraprotein is generally effective in improving platelet function and helps in correcting the bleeding diathesis. Djunic et al 13 showed that paraproteins bind to specific platelet receptors such as the platelet vWF receptor GPIb and platelet collagen receptor GPVI (decreased CD42b and CD36 expression on flow cytometry, respectively.…”

Section: Discussionmentioning

confidence: 99%

Acquired Platelet Dysfunction as a Cause of Bleeding Diathesis: Two Case Studies

Khan¹

2017

HTIJ

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The aims are to highlight the importance of recognizing that clinically significant platelet dysfunction can develop in the background of known causes of bleeding disorders. In this paper, we discuss two patients who developed acquired platelet dysfunction due to eosinophilia with underlying mild Hemophilia A and IgA paraproteinemia that complicated a clinical picture of acquired von Willebrand disease.Case 1: An 8-yr-old boy with known mild haemophilia A presented with abdominal pain and gross haematuria that partially response to Factor VIII concentrate and cryoprecipitate. Tests revealed significant peripheral eosinophilia (AEC 3200/mm 3 ), prolonged bleeding time >15seconds, FVIIIc 31%, normal vWF: Ag and RICOF assays. Functional platelet studies were abnormal and a diagnosis of Acquired Platelet Dysfunction with Eosinophilia (APDE) was made. His symptoms resolved with standard treatment of eosinophilia with anti-histamines, diethylcarbamazine and albendazole.Case 2: A 57-year-old lady was admitted with malena following commencement of oral prednisolone for recently diagnosed Sjogrens syndrome. UGI showed multiple gastric erosions with no response to standard treatment. She was a known diabetic and treated for carcinoma breast 4years ago. A year before this admission, she had her first bleeding episode with epistaxis following septoplasty (APTT prolonged at 40s, not investigated). She finally responded to fresh frozen plasma and cryoprecipitate. Investigations showed APTT 55sec, protein electrophoresis/immune fixation-small spike with IgA lambda and normal SFLC ratio. The mucosal bleeds with partial response to cryoprecipitate and FFP was suggestive of aVWD. Functional platelet studies were abnormal and a diagnosis of paraprotein associated acquired platelet dysfunction was made. She responded to rituximab with reduction in IgA levels and no further bleeds and remains on bortezomib. Identification of acquired platelet dysfunction and knowledge of how that may affect bleeding risk with existing complex autoimmune/hematological disorders are important in optimizing patient care.

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Incidence of Platelet Dysfunction by Thromboelastography–Platelet Mapping in Children Supported with ECMO: A Pilot Retrospective Study

Cited by 46 publications

References 36 publications

Platelet‐mapping assay for monitoring antiplatelet therapy during mechanical circulatory support in children: A retrospective observational study

Platelet‐mapping assay for monitoring antiplatelet therapy during mechanical circulatory support in children: A retrospective observational study

TEG Platelet Mapping and Impedance Aggregometry to Predict Platelet Transfusion During Cardiopulmonary Bypass in Pediatric Patients

Acquired Platelet Dysfunction as a Cause of Bleeding Diathesis: Two Case Studies

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