Hypothermic cardiopulmonary bypass as a determinant of late thrombocytopenia following cardiac operations in pediatric patients.
BACKGROUND
Thrombocytopenia after cardiac operations is a common event in both adult and pediatric patients. Late thrombocytopenia (LTCP) is a less common event that is still without a well-recognized cause. This study explores the role of heparin-induced thrombocytopenia (HIT) and other factors (complexity of the operation, temperature management, and drug use) in determining LTCP.


METHODS
We conducted an observational study of 63 consecutive patients aged <36 months operated with or without cardiopulmonary bypass (CPB). LTCP was defined as a platelet count <100,000 cells/microl or <50% of the pre-operative count at any point in time between post-operative days 5 and 10. A diagnostic test for heparin-platelet factor 4 (PF4) antibodies was performed in patients with LTCP. Other pre- and post-operative factors were investigated for their association with LTCP.


RESULTS
LTCP occurred in 15 (24%) patients. No patient had positive heparin-PF4 antibodies. The lowest temperature on CPB was an independent predictor of LTCP, with a cut-off value at 29 degrees C (sensitivity 80%, specificity 70%). Other factors associated with LTCP were prolonged post-operative use of unfractionated heparin and milrinone. LTCP was associated with increased post-operative morbidity.


CONCLUSIONS
LTCP was related to a combination of factors (operation severity, degree of hypothermia during CPB, prolonged use of unfractionated heparin, and milrinone). The individual contribution of each factor seems difficult to establish. However, the degree of hypothermia during CPB and drug-associated effects were identified. HIT could be excluded in all cases.
Ranucci
M
M
Department of Cardiothoracic-vascular Anesthesia and Intensive Care, IRCCS Policlinico S.Donato, Milan, Italy. cardioanestesia@virgilio.it
Carlucci
C
C
Isgrò
G
G
Brozzi
S
S
Boncilli
A
A
Costa
E
E
Frigiola
A
A
D000758:Anesthesia; D000906:Antibodies / Q000032:analysis; D000925:Anticoagulants / Q000009:adverse effects; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000276:immunology; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome
D000906:Antibodies; D000925:Anticoagulants; D010978:Platelet Factor 4; D006493:Heparin