Platelet hyporeactivity in young infants during cardiopulmonary bypass.

UNLABELLED Platelet dysfunction is one of the most important factors contributing to a postoperative hemorrhagic diathesis in children with congenital heart disease undergoing operations requiring cardiopulmonary bypass (CPB). However, very little is known about the influence of CPB on platelets in neonates and young infants. We studied 16 patients--8 young infants (<2 mo old) and 8 children (>12 mo old)--with congenital heart disease undergoing CPB. Surface density of an important platelet adhesive receptor, glycoprotein Ib, and degree of platelet activation, indicated by p-selectin positivity, were measured by whole blood flow cytometry in samples obtained at seven time points during the operations. We found that the percentage of p-selectin-positive platelets increased significantly in children, but not in young infants, during CPB. The young infant group exhibited a significantly smaller reduction of glycoprotein Ib than the child group during CPB (21.0% +/- 12.0% vs 32.7% +/- 18.1%; P < 0.05). Lack of CPB-induced increase of p-selectin and a smaller decrease of glycoprotein Ib in young infants in the current study suggest reduced platelet reactivity in young infants and neonates during CPB. The clinical significance of the reduced platelet reactivity in young infants and neonates remains to be determined. IMPLICATIONS Platelets of young infants are less reactive than those of children during cardiopulmonary bypass, as determined by the cardiopulmonary bypass-induced alterations in platelet membrane adhesive receptors.

[1]  T. Kühne,et al.  Neonatal platelet physiology and pathophysiology , 1998, European Journal of Pediatrics.

[2]  K. Kanter,et al.  Predicting and Treating Coagulopathies After Cardiopulmonary Bypass in Children , 1997, Anesthesia and analgesia.

[3]  J. Loscalzo,et al.  In vivo tracking of platelets: circulating degranulated platelets rapidly lose surface P-selectin but continue to circulate and function. , 1996, Proceedings of the National Academy of Sciences of the United States of America.

[4]  A. Michelson.  Flow cytometry: a clinical test of platelet function. , 1996, Blood.

[5]  T. Shankey,et al.  Aprotinin modulation of platelet activation in patients undergoing cardiopulmonary bypass operations. , 1996, The Annals of thoracic surgery.

[6]  M. Siimes,et al.  Bleeding and use of blood products after heart operations in infants. , 1995, The Journal of thoracic and cardiovascular surgery.

[7]  A. Michelson,et al.  Neonatal Platelets Are Less Reactive than Adult Platelets to Physiological Agonists in Whole Blood , 1994, Thrombosis and Haemostasis.

[8]  J. Aldag,et al.  Platelet ultrastructure of high-risk premature infants. , 1994, Thrombosis research.

[9]  B. Smith,et al.  Platelet-leukocyte activation and modulation of adhesion receptors in pediatric patients with congenital heart disease undergoing cardiopulmonary bypass. , 1994, The Journal of thoracic and cardiovascular surgery.

[10]  W. Greeley.  Cardiac surgery and postoperative management. , 1993, Critical care medicine.

[11]  K. Takagi,et al.  Platelet dysfunction during cardiopulmonary bypass surgery. With special reference to platelet membrane glycoproteins. , 1993, ASAIO journal.

[12]  Z. Su,et al.  Mechanism of the preserving effect of aprotinin on platelet function and its use in cardiac surgery , 1993 .

[13]  B. Pasche,et al.  The platelet function defect of cardiopulmonary bypass. , 1993, Blood.

[14]  G. Hempelmann,et al.  Aprotinin in pediatric cardiac operations: platelet function, blood loss, and use of homologous blood. , 1993, The Annals of thoracic surgery.

[15]  P. Hickey,et al.  Coagulation defects in neonates during cardiopulmonary bypass. , 1993, The Annals of thoracic surgery.

[16]  J. Mathew,et al.  Cardiopulmonary bypass induces leukocyte-platelet adhesion. , 1992, Blood.

[17]  R. Hillman,et al.  Platelet activation and aggregation during cardiopulmonary bypass. , 1991, Anesthesiology.

[18]  R. Bartlett,et al.  Prophylactic administration of tranexamic acid preserves platelet numbers during extracorporeal circulation in rabbits. , 1991, ASAIO transactions.

[19]  J. Aldag,et al.  Electron microscopic characterization of neonatal platelet ultrastructure: effects of sampling techniques. , 1991, Thrombosis research.

[20]  L. Harker,et al.  Bleeding complications associated with cardiopulmonary bypass. , 1990, Blood.

[21]  C. Abrams,et al.  Direct detection of activated platelets and platelet-derived microparticles in humans. , 1990, Blood.

[22]  J. Hoxie,et al.  Detection of activated platelets in whole blood using activation- dependent monoclonal antibodies and flow cytometry , 1987 .

[23]  L. Harker.  Bleeding after cardiopulmonary bypass. , 1986, The New England journal of medicine.

[24]  I D Arad,et al.  The Mean Platelet Volume (MPV) in the Neonatal Period , 1986, American journal of perinatology.

[25]  J. Fareed,et al.  Cyanotic Congenital Heart Disease in Children: Hemostatic Disorders and Relevance of Molecular Markers of Hemostasis , 1984, Seminars in thrombosis and hemostasis.

[26]  L. Sieger,et al.  Whole blood platelet volumes in newborn infants. , 1982, The Journal of pediatrics.

[27]  H. Ekert,et al.  Preoperative and postoperative platelet function in cyanotic congenital heart disease. , 1974, The Journal of thoracic and cardiovascular surgery.