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ORIGINAL RESEARCH article

Front. Pediatr.
Sec. Pediatric Critical Care
Volume 12 - 2024 | doi: 10.3389/fped.2024.1453182

Quantitative and functional changes in platelets and fibrinogen following cardiopulmonary by-pass in children

Provisionally accepted
Margherita Plebani Margherita Plebani 1*David Longchamp David Longchamp 2Pauline Lauwers Pauline Lauwers 2Stefano C. Di Bernardo Stefano C. Di Bernardo 3Maria-Helena Perez Maria-Helena Perez 2
  • 1 Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne,, Lausanne, Switzerland
  • 2 Pediatric Intensive Care Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
  • 3 Pediatric Cardiology, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

The final, formatted version of the article will be published soon.

    Introduction: Cardiopulmonary bypass (CPB) causes coagulopathy, increasing the risk of postoperative bleeding and mortality. The underlying causes of post-CPB coagulopathy and the factors associated with its occurrence are not yet fully understood. This study assesses platelet and fibrinogen concentration and function following CPB in children with congenital heart diseases (CHD). Methods: We analyzed prospective data from 104 patients aged 0 to 16 years who underwent CPB surgery for CHD. Blood samples were collected before surgery and within 30 minutes of CPB completion. In addition to usual coagulation tests, functional analyses were performed using point of care systems with thromboelastometry and impedance aggregometry. Results: Platelet count, fibrinogen concentration, and platelet and fibrinogen activities significantly decreased after CPB. The duration of CPB was directly associated with a reduction in platelet count and fibrinogen level (r=-0.38, p<0.001; r=-0.21, p=0.03, respectively), but not with their measured activity. Postoperative percentages of baseline values for platelet count (58.36% [43.34 - 74.44] versus 37.44% [29.81 - 54.17], p<0.001) and fibrinogen concentration (73.68% [66.67 - 82.35] versus 65.22% [57.89 - 70.83], p<0.001) were significantly higher in patients who did not experience hypothermia during surgery. Age was inversely associated with the decrease in platelet count (r=0.63, p<0.001), TRAPTEM AUC (r=0.43, p<0.001), fibrinogen concentration (r=0.44, p<0.001) and FIBTEM MCF (r=0.57, p<0.001). Conclusion: Post-CPB coagulopathy is multifactorial and not solely attributed to hemodilution. It also involves functional changes in coagulation cascade components, which can be demonstrated by thromboelastometry and impedance aggregometry. Young children, patients requiring prolonged CPB surgery, or those experiencing hypothermia are particularly affected.

    Keywords: Platelet, Fibrinogen, Rotem, Cardiopulmonary Bypass, coagulopathy, Children, congenital heart disease

    Received: 22 Jun 2024; Accepted: 03 Sep 2024.

    Copyright: © 2024 Plebani, Longchamp, Lauwers, Di Bernardo and Perez. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Margherita Plebani, Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne,, Lausanne, Switzerland

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.