Measurement of primary hemostasis potential with platelet function analyzer to investigate the predictive effect on post-operative blood loss in cyanotic and acyanotic pediatric patients

Abstract

Aim: To investigate hemostatic parameters, including primary hemostasis potential in twenty pediatric patients with or without cyanosis undergoing cardio-pulmonary bypass (CPB) and cardiac surgery to repair congenital defects.

Methods: The platelet function analyzer is an instrument that provides a rapid, in vitro, quantitative measurement of platelet adhesion and aggregation in whole blood flowing through a small aperture under high shear conditions. Other parameters monitored included blood loss, prothrombin time, anti-thrombin 3 activity, and fibrinogen and D-dimer levels. Additionally, hematocrit and albumin levels were monitored to assess the level of hemodilution during CPB.

Results: Both, cyanotic and acyanotic pediatric patients had evidence of supranormal primary hemostasis potential. Although, measurements in cyanotic patients exhibited a higher percentage ratio, this was found to be statistically insignificant between cyanotic and acyanotic patients (collagen-epinephrine p=0.07 and, collagen and adenosine diphosphate (ADP) p=0.248). While, in preoperative period, measurements of primary hemostasis potential, coagulation and fibrinolytic system parameters demonstrated no statistically significant difference between cyanotic and acyanotic patients, measurement of prothrombin time, international normalized ratio and thrombin time levels significantly changed in cyanotic patients, after the operation (p<0,05). Longer cardio-pulmonary bypass time in cyanotic patients could be responsible for this indifference.

Conclusion: The results of our study suggest that the platelet function analyzer system may be an indicator that it can predict bleeding in the postoperative period.