Marked changes in platelet count and function following pediatric congenital heart surgery

Abstract

Both platelet count and platelet function were significantly reduced after CPB in children undertaken correctional heart surgery. Duration of CPB and hypothermia was associated with significant changes in platelet function.

Changes in thrombin generation in children after cardiac surgery and ex-vivo response to blood products and haemostatic agents

“…As part of a larger study including children undertaken CPB [3], we determined thrombin generation in 29 children in both PPP and PRP before and after CPB. The congenital heart diseases ranged from simple malformations to complex cardiac malformations.…”

“…These differences in results obtained from PPP and PRP were also found in the present study. As we have previously shown that platelet count varies greatly after congenital heart surgery and a strong association exists between platelet count and platelet function [3], we adjusted the platelet count in PRP to approximately 100 Â 10 9 /l to eliminate the influence of platelet count per se.…”

“…It has been reported that 11% of adult patients had excessive bleeding after CPB, and the cause was in most cases nonsurgical [1]. In previous studies, we demonstrated an impaired haemostasis after CPB also in children undergoing surgery due to congenital heart disease [2,3]. The haemostatic impairment after CPB is caused by a combination of dilutional and consumptive coagulopathies, increased fibrinolysis [4], insufficient reversal of heparin with protamine sulfate [5] and a reduction in platelet count and function [6] as well as the intermittently induced hypothermia [7].…”

“…None of the children received any medication interfering with coagulation or platelet function prior to surgery. The same patients were included in a previously published study on platelet function [3], but due to logistic reasons, thrombin generation could not be performed in the children included in the beginning of the study period. For subgroup analyses, the children were divided into two groups depending on the amount of postoperative bleeding; bleeders (!…”

In-line filtration decreases systemic inflammatory response syndrome, renal and hematologic dysfunction in pediatric cardiac intensive care patients

“…In our study, this deleterious linkage becomes clinically apparent in the control group: Patients without in-line filters suffered from a higher incidence of SIRS and coagulopathy. Especially in patients after cardiac surgery with CPB, the physiological hemostasis of the coagulation system is altered for several days postoperatively [8,21] as the contact of blood to the artificial surfaces of the CPB circuit causes an activation and consumption of platelets and coagulation factors [8]. A further infusion of particles on ICU as in the control group may additionally trigger the coagulation cascade and contribute to the coagulopathy.…”