title: Hepatic dysfunction contributes to coagulation disturbances in patients undergoing whole body hyperthermia by use of extracorporeal circulation.
abstract: OBJECTIVE
  This phase I study was performed to evaluate coagulation alterations during extracorporeal circulation (ECC) induced whole body hyperthermia (WBHT) in 12 patients with advanced soft tissue sarcomas.
  
  
  METHODS
  To distinguish between effects of normothermic ECC and ECC-WBHT, blood samples were drawn at different time points: at baseline, after 30 min on normothermic ECC, at the end of the heating period, and 24 h and 7 days thereafter. Standard coagulation tests, coagulation factors, thrombelastography,platelets and reticulated platelets, liver enzymes, and scintigraphic platelet imaging were performed.
  
  
  RESULTS
  Normothermic ECC resulted in coagulation alterations most likely due to systemic anticoagulation. Induction of hyperthermia caused thrombocytopenia, increased fibrin degradation products,prolonged clotting times, alteration in coagulation factors, and increased liver enzymes. The majority of these effects was most pronounced 24 h after ECC-WBHT. In addition, late liver sequestration of platelets was demonstrated in scintigraphic imaging at that time point.
  
  
  CONCLUSIONS
  Temporal correlation between hemostatic alterations and elevation in liver enzymes leads to the assumption that liver impairment might play a crucial role in coagulation disturbances observed during ECC-WBHT and thereafter, thus strongly supported by liver sequestration of platelets.Therefore a close monitoring of hepatic derived coagulation alterations in patients undergoing extracorporeal whole body hypothermia is warranted.
authors.forename: Nina
authors.initials: N
authors.lastname: Worel
authors.forename: Paul
authors.initials: P
authors.lastname: Knöbl
authors.forename: Georgios
authors.initials: G
authors.lastname: Karanikas
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Fuchs
authors.forename: Andja
authors.initials: A
authors.lastname: Bojic
authors.forename: Thomas
authors.initials: T
authors.lastname: Brodowicz
authors.forename: Petra
authors.initials: P
authors.lastname: Jilma
authors.forename: Christoph C
authors.initials: CC
authors.lastname: Zielinski
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Köstler
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001317:Austria; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D001780:Blood Coagulation Tests; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D017093:Liver Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012509:Sarcoma / Q000556:secondary / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants