title: Preoperative platelet dysfunction predicts blood product transfusion in children undergoing cardiac surgery.
abstract: OBJECTIVE
  Excessive bleeding can be a problem during or after cardiac surgery. While cardiopulmonary bypass-associated platelet dysfunction is an important inducer of coagulopathy, preoperative platelet dysfunction can also contribute to this bleeding. We investigated the relationship between preoperative platelet dysfunction and transfusion of blood products given to children undergoing cardiac surgery.
  
  
  METHODS
  The platelet function analyser test measures platelet function in vitro by aspirating blood through a small standard hole (creating high shear) in a collagen membrane infused with a platelet agonist. The time taken to form a platelet plug is known as closure time and prolonged closure time (CT) indicates platelet dysfunction. Three hundred and thirty-eight children who had undergone surgery with cardiopulmonary bypass between 2008 and 2012 were included. The volume of red blood cells and fresh-frozen plasma transfused was recorded. The relationship between closure time and transfusion requirements was analysed using linear and logistic regression.
  
  
  RESULTS
  Patients with prolonged closure time had greater odds of getting red blood cells and fresh-frozen plasma transfusions compared with patients with normal closure time (P <0.01). On univariate analysis, age, weight, haematocrit, cardiopulmonary bypass time, Risk Adjustment for Congenital Heart Surgery score and closure time were associated with increased odds of red blood cells and fresh-frozen plasma transfusion in the operation theatre (P <0.05). However, when logistic multivariable regression analysis was applied, only age, cardiopulmonary bypass time and closure time remained as significant predictive factors for transfusion.
  
  
  CONCLUSIONS
  In children who have undergone cardiac surgery, when age and cardiopulmonary bypass time are accounted for, a prolonged preoperative closure time is significantly associated with increased odds of red blood cells and fresh-frozen plasma transfusion in the operation theatre. This may have implications for planning and utilization of blood products.
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: M Mujeeb
authors.initials: MM
authors.lastname: Zubair
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Bailly
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Gurion
authors.initials: G
authors.lastname: Lantz
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Sunstrom
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Saharan
authors.affiliation: Division of Hematology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Lynn K
authors.initials: LK
authors.lastname: Boshkov
authors.affiliation: Division of Hematology, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Sochacki
authors.affiliation: Perinatal Division, Department of Obstetrics, Oregon Health & Science University, Portland, OR, USA.
authors.forename: A
authors.initials: A
authors.lastname: Roger Hohimer
authors.affiliation: Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lasarev
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA langleys@ohsu.edu.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Langley
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007223:Infant; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010949:Plasma; D015539:Platelet Activation; D010979:Platelet Function Tests; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cardiopulmonary bypass; Congenital heart disease; Paediatric; Platelets