Hematologic Changes During and Following Cardiopulmonary Bypass and Their Relationship to Non-Surgical Blood Loss. 2. Oncotic, Opsonic and Clotting Proteins
Abstract
Plasma proteins, D-dimer, prothrombin time (PT) and partial Thromboplastin time (PTT) were measured before, during, and up to 72 hours following cardiopulmonary bypass (CPB) in 100 adult patients undergoing cardiac surgery. The Plasma proteins included total protein and albumin (oncotic proteins), Immunoglobulins G and M, C3, fibronectin (oncotic proteins), and fibrinogen, Factor VIIIc, Factor VIII-vWF protein, antithrombin III, and plasminogen. Postoperative blood loss was measured after administering the first dose of protamine to reverse the heparin. Fifteen patients had surgical bleeding and were excluded from the data analysis. Preoperatively, abnormally high levels of fibrinogen and C3 were observed in the 85 patients that were analyzed. After correcting for the effect of hemodilution at 20 minutes after the institution of CPB, there was an increase in the plasma concentration of the measured proteins except for IgG, IgM, C3, and FVIII-vWF. During the 72-hour post-CPB period, the oncotic and oncotic proteins remained depressed below preoperative levels, while the clotting proteins fibrinogen, FVIIIc, and FVIII-vWF increased to levels significantly higher than preoperative levels. None of the parameters reported in this study correlated by multivariate regression analysis to the blood loss during the 4-hour post-CPB period. Plasma C3 correlated inversely and univariately with the blood loss and with the duration of CPB. The level of D-dimer at 2 hours post-CPB correlated by and multivariate analysis to the template bleeding time measured at the same time. (1) A "plasma refill" phenomenon occurred during the initial period of CPB. (2) Changes in plasma protein levels (including FVIII-vWF) did not predict postoperative blood loss. (3) The relationship between D-dimer and the bleeding time suggested that fibrinolysis might contribute to the platelet dysfunction induced by cardiopulmonary bypass.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 31, 1990
- Accession Number
- ADA360209
Entities
People
- Gina Ragno
- Irma O. Szymanski
- J. A. Wolfe
- Shukri F. Khuri
- Trevor C. Axford
Organizations
- Boston University