Modified ultrafiltration attenuates dilutional coagulopathy in pediatric open heart operations.
BACKGROUND
Extreme hemodilution caused by relatively large prime volumes required for cardiopulmonary bypass in infants causes a dilutional coagulopathy, characterized by low concentrations of fibrinogen and other circulating coagulation factors. Modified ultrafiltration results in hemoconcentration and is associated with decreases in postoperative bleeding and transfusion requirements in children. This study was undertaken to quantify the effect of modified ultrafiltration on concentrations of fibrinogen, plasma proteins, and platelets in infants and small children.


METHODS
Twenty patients less than 15 kg were studied. Cardiopulmonary bypass circuits were primed with crystalloid solutions. Red blood cells were added during cardiopulmonary bypass for hematocrits less than 15%. Colloid solutions were not administered. Concentrations of fibrinogen, plasma proteins, and platelets, and hematocrit were measured before cardiopulmonary bypass, before modified ultrafiltration, and after modified ultrafiltration.


RESULTS
Modified ultrafiltration was associated with significant (p < 0.001) increases in hematocrit (19% +/- 6% to 31% +/- 9%), fibrinogen (65 +/- 29 to 101 +/- 45 mg/dL), and total plasma proteins (2.7 +/- 0.3 to 4.9 +/- 0.7 g/dL), but no change (p = 0.129) in platelet count.


CONCLUSIONS
We conclude that modified ultrafiltration significantly attenuates the dilutional coagulopathy associated with cardiopulmonary bypass in infants.
Friesen
R H
RH
Department of Anesthesiology, The Children's Hospital, University of Colorado, Denver 80218, USA.
Campbell
D N
DN
Clarke
D R
DR
Tornabene
M A
MA
D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000628:therapy*; D001779:Blood Coagulation Factors / Q000032:analysis; D001798:Blood Proteins / Q000032:analysis; D006348:Cardiac Surgical Procedures; D002314:Cardioplegic Solutions; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005340:Fibrinogen / Q000032:analysis; D006330:Heart Defects, Congenital / Q000601:surgery; D006400:Hematocrit; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007223:Infant; D010976:Platelet Count
D001779:Blood Coagulation Factors; D001798:Blood Proteins; D002314:Cardioplegic Solutions; D005340:Fibrinogen