Is blood accumulation under alkalemia related to platelet aggregation or thrombus formation during cardiopulmonary bypass surgery?

Soyama, Tomonori; Yoshida, Hideto; Shimomura, Daiki; Takahashi, Yukihiro

doi:10.7130/jject.40.1

Cited by 1 publication

(3 citation statements)

References 6 publications

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“…ering that PT and APTT were markedly prolonged in the NaHCO 3 100 and 200 conditions with a very low SFMC, and that platelet aggregation ability was not enhanced under the alkalemic conditions in our previous study, it is unlikely that blood clotting in the circuit with alkalemia was caused by enhanced blood coagulation ability or platelet aggregation. 9,21,22) We also morphologically demonstrated an increase in the number of echinocytes under the alkalemic conditions used in our previous study, 8) an observation consistent with the present findings.…”

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confidence: 92%

“…8) In contrast, platelet aggregation and blood coagulation were not enhanced under these conditions. 9) We also confirmed that the presence of albumin under alkalemic conditions inhibited the appearance of echinocytes. This suggested that blood clotting in the circuit soon after initiating CPB could be prevented with albumin.…”

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confidence: 74%

“…It has been postulated that blood clotting in the circuit soon after initiating CPB is caused by echinocytes that form as a result of contact between the alkalized priming fluid and blood. We have previously investigated in vitro the frequency of echinocytes, platelet aggregation, and blood coagulation abilities under alkalemic conditions, 8,9) demonstrating that the frequency of echinocytes increased under such conditions. 8) In contrast, platelet aggregation and blood coagulation were not enhanced under these conditions.…”

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confidence: 99%

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Alkalemic conditions result in blood clotting in the circuit soon after initiating cardiopulmonary bypass

Soyama

Takahashi

Yoshida

et al. 2016

JJECT

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Purpose : This study investigated the relationship between blood clotting in the circuit soon after initiating cardiopulmonary bypass (CPB) and echinocytes that appear with alkalemia, using a recirculation circuit filled with heparinized bovine blood.Methods : Alkalemic conditions in the recirculation circuit were prepared by adding various concentrations of NaHCO 3 to the priming fluid. Albumin was also added to confirm its inhibitory effect on blood clotting. Blood pH, hold-up, the pressure gradient, and red blood cell (RBC) reduction rate were monitored. Blood clots were examined microscopically.Results : Although blood pH was elevated under all experimental conditions, clotting in the circuit increased with increased concentrations of HCO3 -. Albumin inhibited the clotting under the same alkalemic conditions. Microscopic findings revealed echinocytes in the blood clots.Conclusions : The shape of echinocytes was transformed by a reduction in the Donnan equilibrium ratio because of changes in pH inside and outside the RBC membrane. Blood clotting in the circuit soon after initiating CPB may be caused by echinocytes that appear under alkalemic conditions. This was inhibited by albumin, suggesting that the addition of albumin to the priming fluid may prevent such clotting in the circuit after initiating CPB.

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