The influence of cardiopulmonary bypass on the size of human platelets

Laufer, Neri; Merin, Gideon; Grover, N.B.; Pessachowicz, B.; Borman, Joseph B.

doi:10.1016/s0022-5223(19)40305-x

Cited by 34 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CPB produces defects in hemostasis associated with reductions in PLT number, 42,46‐50 PLT size, 51‐55 and plasma‐clotting proteins; 33,35,56‐58 acquired PLT dysfunction; 43,59‐66 increased fibrinolytic activity; 36,37,67‐69 inadequate or excessive heparinization; and inadequate or excessive protamine neutralization. Several mechanisms have been suggested as the source of PLT dysfunction after CPB 42,43,59‐66 .…”

Section: The Effect Of Skin Temperature On Plt Function In Extracorpomentioning

confidence: 99%

Nonsurgical bleeding diathesis in anemic thrombocytopenic patients: role of temperature, red blood cells, platelets, and plasma‐clotting proteins

2007

View full text Add to dashboard Cite

Research at the Naval Blood Research Laboratory (Boston, MA) for the past four decades has focused on the preservation of red blood cells (RBCs), platelets (PLTs), and plasma-clotting proteins to treat wounded servicemen suffering blood loss. We have studied the survival and function of fresh and preserved RBCs and PLTs and the function of fresh and frozen plasma-clotting proteins. This report summarizes our peer-reviewed publications on the effects of temperature, RBCs, PLTs, and plasma-clotting proteins on the bleeding time (BT) and nonsurgical blood loss. The term nonsurgical blood loss refers to generalized, systemic bleeding that is not corrected by surgical interventions. We observed that the BT correlated with the volume of shed blood collected at the BT site and to the nonsurgical blood loss in anemic thrombocytopenic patients after cardiopulmonary bypass surgery. Many factors influence the BT, including temperature; hematocrit (Hct); PLT count; PLT size; PLT function; and the plasma-clotting proteins factor (F)VIII, von Willebrand factor, and fibrinogen level. Our laboratory has studied temperature, Hct, PLT count, PLT size, and PLT function in studies performed in non-aspirin-treated and aspirin-treated volunteers, in aspirin-treated baboons, and in anemic thrombocytopenic patients. This monograph discusses the role of RBCs and PLTs in the restoration of hemostasis, in the hope that a better understanding of the hemostatic mechanism might improve the treatment of anemic thrombocytopenic patients. Data from our studies have demonstrated that it is important to transfuse anemic thrombocytopenic patients with RBCs that have satisfactory viability and function to achieve a Hct level of 35 vol percent before transfusing viable and functional PLTs. The Biomedical Excellence for Safer Transfusion (BEST) Collaborative recommends that preserved PLTs have an in vivo recovery of 66 percent of that of fresh PLTs and a life span that is at least 50 percent that of fresh PLTs. Their recommendation does not include any indication that preserved PLTs must be able to function to reduce the BT and reduce or prevent nonsurgical blood loss. One of the hemostatic effects of RBC is to scavenge endothelial cell nitric oxide, a vasodilating agent that inhibits PLT function. In addition, endothelin may be released from endothelial cells, a potent vasoconstrictor substance,to reduce blood flow at the BT site. RBCs, like PLTs at the BT site, may provide arachidonic acid and adenosine diphosphate to stimulate the PLTs to make thromboxane, another potent vasoconstrictor substance and a PLT-aggregating substance. At the BT site, the PLTs and RBCs are activated and phosphatidyl serine is exposed on both the PLTs and the RBCs. FVa and FXa, which generate prothrombinase activity to produce thrombin, accumulate on the PLTs and RBCs. A Hct level of 35 vol percent at the BT site minimizes shear stress and reduces nitric oxide produced by endothelial cells. The transfusion trigger for prophylactic PLT transfusion should consider both the H...

show abstract

Section: The Effect Of Skin Temperature On Plt Function In Extracorpomentioning

confidence: 99%

Nonsurgical bleeding diathesis in anemic thrombocytopenic patients: role of temperature, red blood cells, platelets, and plasma‐clotting proteins

2007

View full text Add to dashboard Cite

show abstract

“…Thrombocytopenia following extracorporeal circulation is a recognized hazard of open heart surgery. Selective removal of large platelets has been reported by Laufer et al (1975) who suggested that this indicated removal of younger more active platelets. We found a similar, though less marked, fall in the MPV in the immediate postoperative specimen (Table 2).…”

Section: Discussionmentioning

confidence: 91%

Variation in platelet size during recovery from thrombocytopenia following extracorporeal circulation

Bailey

Antonas

2008

Clinical &Amp; Laboratory Haematology

View full text Add to dashboard Cite

Summary. Serial platelet counts and measurements of mean platelet volume have been performed on patients who became thrombocytopenic during open heart surgery. The results show that large platelets are released from the bone marrow during the 48 hours following the operation as a primary response to an acute increase in demand. During this period there is only a gradual recovery of the platelet count. In the subsequent days there is an acceleration of platelet production and a simultaneous reduction in platelet volume. These results suggest a change in the nature of the stimulus following the initial postoperative period, indicating a close relationship between platelet size and the total platelet count. Platelet size, therefore, may not be wholly dependent upon either megakaryocytic heterogeneity or platelet age.

show abstract

“…Bypass produces a heterogeneous mixture of circulating platelets that include discoid and shape-changed intact platelets, partially and completely degranulated platelets, granulated platelets with deficient membrane receptors, destroyed platelet ghosts, membrane fragments, and new platelets released from the bone marrow. 18 The relative proportions differ between patients and between different perfusion circuits. The result is fewer circulating platelets that function poorly.…”

Section: Exposure Of Receptormentioning

confidence: 99%

Effects of cardiopulmonary bypass on the coagulation system

Edmunds

1993

Cardiol Young

View full text Add to dashboard Cite

Cardiopulmonary bypass makes a mess of homeostasis. Extracorporeal perfusion produces pulseless flow without physiologic controls, showers microemboli throughout the body, and brings blood diluted with additives to an enzymatic boil. Much of the morbidity associated with open heart surgery is due to contact of blood with the synthetic surfaces of the extracorporeal perfusion circuit. Bypass temporarily impairs function of every organ, alters concentrations of over 25 vasoactive substances within the plasma, and causes massive retention of fluid. In short, cardiopulmonary bypass makes patients sick.

show abstract

The influence of cardiopulmonary bypass on the size of human platelets

Cited by 34 publications

References 11 publications

Nonsurgical bleeding diathesis in anemic thrombocytopenic patients: role of temperature, red blood cells, platelets, and plasma‐clotting proteins

Nonsurgical bleeding diathesis in anemic thrombocytopenic patients: role of temperature, red blood cells, platelets, and plasma‐clotting proteins

Variation in platelet size during recovery from thrombocytopenia following extracorporeal circulation

Effects of cardiopulmonary bypass on the coagulation system

Contact Info

Product

Resources

About