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Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery
Yoshio Ootaki1, Masahiro Yamaguchi, Yoshihiro Oshima
1Department of Cardiothoracic Surgery, Kobe Children's Hospital, Hyogo, Japan.
Insights
Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children improves hematocrit and plasma proteins. MUF also enhances key coagulation factors, attenuating dilutional coagulopathy in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Hemostasis and Thrombosis
Background:
- Cardiopulmonary bypass (CPB) in children can lead to dilutional coagulopathy.
- Modified ultrafiltration (MUF) is a technique used post-CPB to reduce blood loss and transfusion needs.
- The impact of MUF on specific coagulation factors in pediatric patients requires further quantification.
Purpose of the Study:
- To quantify the effects of modified ultrafiltration (MUF) on coagulation factors in pediatric patients undergoing open-heart surgery.
- To assess MUF's role in mitigating dilutional coagulopathy during CPB.
Main Methods:
- Seven pediatric patients with congenital heart defects undergoing open-heart surgery were studied.
- CPB circuits were primed with crystalloid solutions without blood transfusions.
- Measurements included hematocrit, platelet count, total plasma proteins, albumin, fibrinogen, prothrombin, and factors VII, IX, and X pre-CPB, post-CPB, and post-MUF.
Main Results:
- MUF significantly increased hematocrit, platelet count, total plasma proteins, and albumin (P < 0.05).
- Fibrinogen, prothrombin, and factor VII levels also showed significant increases during MUF (P < 0.05).
- Factors IX and X did not demonstrate significant changes following MUF.
Conclusions:
- Modified ultrafiltration (MUF) attenuates dilutional coagulopathy in pediatric patients after cardiopulmonary bypass (CPB).
- MUF leads to slight improvements in several coagulation factors, contributing to better hemostasis.
Purpose:
Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children has been reported to reduce the need for postoperative blood transfusion and minimize postoperative blood loss. This study was undertaken to quantify the effects of MUF on coagulation factors in pediatric patients.
Methods:
Seven children scheduled to undergo open-heart surgery for congenital heart defects were studied. CPB circuits were primed with crystalloid solutions and no blood transfusions were performed. Hematocrit, platelet count, total plasma proteins, albumin, fibrinogen, prothrombin, factor VII, factor IX, and factor X were measured preoperatively, at the termination of cardiopulmonary bypass, and at the end of modified ultrafiltration.
Results:
MUF was associated with significant (P < 0.05) increases in hematocrit (17.6% +/- 1.6% to 21.6% +/- 2.4%), platelet count 11.1 +/- 2.5 to 12.8 +/- 2.4 x 10(4)/mm3), total plasma proteins (2.7 +/- 0.3 to 3.4 +/- 0.4 g/dl), and albumin (1.6 +/- 0.2 to 2.1 +/- 0.2 g/dl). Fibrinogen, prothrombin, and factor VII also increased significantly (P < 0.05) during MUF, but factor IX and factor X did not change.
Conclusion:
We conclude that MUF attenuates the dilutional coagulopathy that occurs during CPB in children. There were slight improvements in the coagulation factors when MUF was employed.