title: How do we manage cardiopulmonary bypass coagulopathy?
abstract: BACKGROUND
  Patients who undergo cardiopulmonary bypass (CPB) are at risk for coagulopathy. Suboptimal turnaround time (TAT) of laboratory coagulation testing results in empiric administration of blood products to treat massive bleeding. We describe our initiative in establishing the coagulation-based hemotherapy (CBH) service, a clinical pathology consultation service that uses rapid TAT coagulation testing and provides comprehensive assessment of bleeding in patients undergoing CPB. A transfusion algorithm that treats the underlying cause of coagulopathy was developed.
  
  
  METHODS
  The coagulation testing menu includes all aspects of coagulopathy with close proximity of the laboratory to the operating room to allow for rapid test results. The hemotherapy pathologist monitors laboratory results at several stages in surgery and uses a comprehensive algorithm to monitor a patient's hemostasis. The optimal number and type of blood products are selected when the patient is taken off CPB.
  
  
  RESULTS
  The CBH service was consulted for 44 ventricular assist device implants, 30 heart transplants, and 31 other cardiovascular surgeries from May 2012 through November 2013. The TAT for laboratory tests was 15 minutes for complete blood count, antithrombin, and coagulation panel and 30 minutes for VerifyNow and thromboelastography, in comparison to 45 to 60 minutes in normal settings. The transfusion algorithms were used with optimal administration of blood components with preliminary data suggestive of reduced blood product usage and better patient outcomes.
  
  
  CONCLUSIONS
  We described the successful introduction of a novel pathology consultation service that uses a rapid TAT coagulation testing menu with transfusion algorithms for improved management of CPB patients.
authors.affiliation: Department of Pathology and Laboratory Medicine.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Welsh
authors.forename: Elena
authors.initials: E
authors.lastname: Nedelcu
authors.forename: Yu
authors.initials: Y
authors.lastname: Bai
authors.forename: Amer
authors.initials: A
authors.lastname: Wahed
authors.forename: Kimberly
authors.initials: K
authors.lastname: Klein
authors.forename: Hlaing
authors.initials: H
authors.lastname: Tint
authors.forename: Igor
authors.initials: I
authors.lastname: Gregoric
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.forename: Pranav
authors.initials: P
authors.lastname: Loyalka
authors.forename: Sriram
authors.initials: S
authors.lastname: Nathan
authors.forename: Paul
authors.initials: P
authors.lastname: Loubser
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Weeks
authors.forename: Rajko
authors.initials: R
authors.lastname: Radovancevic
authors.forename: Andy N D
authors.initials: AN
authors.lastname: Nguyen
mesh_terms: D000465:Algorithms; D001778:Blood Coagulation Disorders / Q000517:prevention & control*; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D006801:Humans; D013916:Thrombelastography