Platelet count and function in paediatric cardiac surgery: a prospective observational study

Romlin, Birgitta; Söderlund, Fredrik; Wåhlander, Håkan; Nilsson, Bengt; Baghaei, Fariba; Jeppsson, Anders

doi:10.1093/bja/aeu194

Cited by 55 publications

(43 citation statements)

References 27 publications

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“…Similarly, not only does platelet salvage increase the serum platelet count, but also salvaged platelets have preserved platelet aggregation activity. 25,26 A major limitation of our study apart from the small sample size is that it is a pretransfusion analysis. We cannot say whether all our pretransfusion findings will translate into the clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Garg

Malhotra

Desai

et al. 2015

Innovations�(Phila)

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Objective Cell Saver system is the method of choice for red blood cell salvage from the surgical field; however, cost is a limiting factor. We at our institute have devised a cost-effective version of dialyser-based autotransfusion system. We performed pretransfusion comparison of our autotransfusion system with conventional cell saver system. Methods A prospective randomized observational study was performed in 104 consecutive patients with coronary artery disease undergoing by off-pump coronary artery bypass grafting. Patients were divided into two groups. In the dialyser group (53 patients), blood from surgical field was salvaged by our dialyser-based system. In the cell saver group (51 patients), blood was salvaged by cell saver. In both groups, 20-mL sample from the salvaged blood was analyzed for hemoglobin, platelets, protein, albumin, free hemoglobin, osmotic fragility, and peripheral blood smear examination. Results Total hemoglobin salvaged was comparable in both groups (85% vs 76%). On peripheral smear, red blood cells were swollen, but morphology was preserved. Moreover, normal osmotic fragility suggested absence of any lethal damage to red blood cells in either group. Dialyser-based system was more efficient in salvaging platelets (42.9% vs 6%), proteins (79.2% vs 0%), and albumin (65% vs 0%). Total free hemoglobin was three times more in dialyser group but was well below recommended limits. Conclusions Dialyser-based system is economical, is equally efficacious in salvaging red blood cells, is more effective in salvaging platelets and proteins, and does not contain significant amount of free hemoglobin. Therefore, this salvaged blood can be safely transfused.

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Section: Discussionmentioning

confidence: 99%

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Garg

Malhotra

Desai

et al. 2015

Innovations�(Phila)

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“…This possibility is consistent with increasing evidence that platelet function, rather than platelet count, plays a more important role in coagulation. Platelet count cannot be used to evaluate platelet-involved clotting, 28 and some investigators recommend platelet transfusion for patients with clotting time >40 seconds even when platelet counts are as high as 100 × 10 9 /L. 24 One study reported that total platelet counts in cardiac surgery patients were similar between those experiencing small or large blood loss, but that those experiencing small blood loss showed significantly higher functional platelet counts.…”

Section: Discussionmentioning

confidence: 99%

“…6–9 Activated platelets upregulate their surface expression of adhesion molecules such as P-selectin and glycoprotein (GP) IIb/IIIa 6,7,10,11 and release platelet-specific proteins from alpha granules, such as platelet factor 4, which can induce progressive platelet dysfunction. 7,8 This dysfunction is observable as weakened platelet aggregation in response to agonists such as collagen 10 and adenosine diphosphate (ADP). 12 For example, chest tube drainage after surgery has been associated with impaired collagen-induced platelet aggregation.…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery

et al. 2016

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Patients undergoing cardiac surgery often experience abnormal bleeding, due primarily to cardiopulmonary bypass (CPB)-induced activation of platelets. Sevoflurane may inhibit platelet activation, raising the possibility that administering it during CPB may reduce blood loss.Patients between 18 and 65 years old who were scheduled for cardiac surgery under CPB at our hospital were prospectively enrolled and randomized to receive intravenous anesthetics alone (control group, n = 77) or together with sevoflurane (0.5–1.0 vol/%) from an oxygenator (sevoflurane group, n = 76). The primary outcome was postoperative blood loss, the secondary outcome was postoperative need for blood products.Volume of blood loss was 48% lower in the sevoflurane group than the control group at 4 hours after surgery, and 33% lower at 12 hours after surgery. Significantly fewer patients in the sevoflurane group lost >700 mL blood within 24 hours (9 of 76 vs 28 of 77, P < 0.001). As a result, the sevoflurane group received significantly smaller volumes of packed red blood cells (1.25 ± 2.36 vs 2.23 ± 3.75 units, P = 0.011) and fresh frozen plasma (97 ± 237 vs 236 ± 344 mL, P = 0.004). Thus the sevoflurane group was at significantly lower risk of requiring complex blood products after surgery (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17–0.68, P = 0.002).Sevoflurane inhalation from an oxygenator during CPB may reduce blood loss and need for blood products after cardiac surgery.

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“…24 Monitoring the platelet count in parallel with platelet function, the latter measured by techniques such as impedance aggregometry, modified viscoelastometry or flow cytometry, would allow prompt and appropriate treatment to avoid coagulopathy at the end of surgery. The platelet-mapping assay is a modification of thromboelastography, which measures clot strength as a reflection of platelet function, and detects the reduction in percentage platelet aggregation in the presence of collagen, adenosine diphosphate or arachidonic acid.…”

Section: Advance Publication By-j-stagementioning

confidence: 99%

Association Between Platelet Count and Postoperative Blood Loss in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass and Fresh Frozen Plasma Administration Guided by Thromboelastometry

Ichikawa

Osada

Kodaka

et al. 2018

Circ J

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Background: Coagulopathy after cardiopulmonary bypass (CPB) is caused by multiple factors, including reduced coagulation factors and a low platelet count. Methods and Results:In this study, we undertook a post hoc analysis to identify factors associated with increased postoperative blood loss in 97 patients undergoing cardiac surgery with CPB, with fresh frozen plasma administered according to a ROTEM-guided algorithm. We identified 24 patients for the top quartile of postoperative blood loss, >528 mL and defined as having excessive blood loss. Using Spearman's rank correlation test and multivariable linear regression, we reanalyzed the participants' demographic, surgical and anesthetic variables, laboratory test results, blood loss, and transfusion data. Univariate analysis indicated that patients who experienced higher postoperative blood loss received a significantly higher heparin dose, had a higher requirement for fresh frozen plasma transfusion during surgery, and had a significantly lower hematocrit and platelet count at the end of surgery compared with patients without excessive blood loss. Multivariate analysis showed that platelet count at the end of surgery (odds ratio 0.780, 95% confidence interval 0.629-0.967; P=0.024) was an independent factor for excessive blood loss. Conclusions:Low platelet count at the end of surgery was associated with excessive postoperative bleeding during cardiac surgery with CPB.

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Platelet count and function in paediatric cardiac surgery: a prospective observational study

Cited by 55 publications

References 27 publications

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Pretransfusion Comparison of Dialyser-Based Hemoconcentrator with Cell Saver System for Perioperative Cell Salvage

Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery

Association Between Platelet Count and Postoperative Blood Loss in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass and Fresh Frozen Plasma Administration Guided by Thromboelastometry

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