Haemostatic profile of small children during and following cardiopulmonary bypass.
OBJECTIVE
We evaluated changes of the haemostatic system during pediatric cardiac surgery during and after cardiopulmonary bypass (CPB).


METHODS
Twenty-five children under 15 kg of body weight undergoing open-heart surgery were divided into three groups; 9 patients (Group A), no bank blood was used throughout the surgery; 8 patients (Group B), packed red cells were used in the priming of CPB circuit; 8 patients (Group C) in cyanotic condition, for whom surgery was performed without bank blood. CPB caused a significant decrease of platelet counts in all three groups, the levels of which remained similar next morning.


RESULTS
Platelet counts decreased more significantly in Group C (59+/-27 k/mm3) than in Group A (119+/-42 k/mm3) and B (104+/-27 k/mm3). Platelet function-platelet activating factor test (HemoSTATUS) did not significantly decrease throughout the perioperative period in Group A. HemoSTATUS value decreased during CPB and recovered after CPB in Group B and C. Prothrombin time international ratio (PT-INR) and activated partial thromboplastin time were significantly prolonged just after CPB and recovered until next morning in all three groups. PT-INR was more prolonged in Group C (2.92+/-0.62) than in Group A (2.08+/-0.27) and B (2.42+/-0.42). There was no significant difference in postoperative bleeding for the first 12 hours among the three groups.


CONCLUSIONS
Although extreme hemodilution during CPB significantly impairs the coagulation and platelet system, these changes are usually transient and tolerable with minimal postoperative hemorrhage. However, a prolonged CPB and preoperative cyanotic condition may induce a critical decrease of platelet counts and increase postoperative bleeding.
Fukumura
Fumio
F
Department of Cardiovascular Surgery, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Fukuoka, Japan.
Sese
Akira
A
Ueno
Yasutaka
Y
Imoto
Yutaka
Y
Sakamoto
Masato
M
Tanoue
Yoshihisa
Y
Sonoda
Hiromichi
H
D001780:Blood Coagulation Tests; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D006330:Heart Defects, Congenital / Q000097:blood* / Q000601:surgery*; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D007223:Infant; D010979:Platelet Function Tests