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Fibrinogen in children undergoing cardiac surgery: is it effective?
Bruce E Miller1, Steven R Tosone, Nina A Guzzetta
1Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia.
Insights
Fibrinogen in children under 12 months undergoing cardiac surgery is functionally impaired. This study found fibrinogen levels only correlated with modified thromboelastogram maximum amplitude in children aged 12-24 months.
Area of Science:
- Pediatric Hematology
- Coagulation Science
- Cardiovascular Surgery
Background:
- Functional integrity of fibrinogen in young children remains under investigation.
- Adult studies show fibrinogen levels correlate with modified thromboelastogram maximum amplitude (MA).
- This correlation in adults is observed after uncoupling platelet-fibrinogen interactions with glycoprotein IIb/IIIa receptor blockers.
Purpose of the Study:
- To investigate the functional integrity of fibrinogen in infants and young children undergoing cardiac surgery.
- To determine if fibrinogen levels correlate with modified thromboelastogram MA in pediatric populations.
- To identify age-related differences in fibrinogen function.
Main Methods:
- Compared modified and unmodified thromboelastogram variables with fibrinogen levels and platelet counts.
- Studied 250 children under 2 years old undergoing cardiac surgery.
- Analyzed data across five distinct age groups: <1 mo, 1-3 mo, 3-6 mo, 6-12 mo, and 12-24 mo.
Main Results:
- Fibrinogen levels correlated with modified thromboelastogram MAs exclusively in the 12-24 month age group.
- Other fibrinogen-influenced thromboelastogram variables also showed significant correlations in the 12-24 month group.
- Correlations between platelet counts and thromboelastogram variables, similar to adult findings, were significant in the 12-24 month group.
Conclusions:
- Fibrinogen is qualitatively dysfunctional in children under 12 months with congenital heart disease.
- Functional fibrinogen-dependent coagulation improves between 12 and 24 months of age.
- Findings suggest age-specific considerations for managing coagulation in pediatric cardiac surgery patients.
Abstract:
There is speculation based on laboratory tests and biochemical data regarding the functional integrity of the fibrinogen in young children. Recent investigations in adults have demonstrated that their fibrinogen level correlates with the thromboelastogram maximum amplitude (MA) after modification with a glycoprotein IIb/IIIa receptor blocker that uncouples platelet-fibrinogen interactions. We postulate that if the fibrinogen of young children is functionally intact then their fibrinogen levels should also correlate with modified thromboelastogram MA values as they do in adults. We compared modified and unmodified thromboelastogram variables of 250 children <2 yr old undergoing cardiac surgery with their fibrinogen levels and platelet counts. Five age groups were distinguished to determine if and when correlations become significant (<1 mo, 1-3 mo, 3-6 mo, 6-12 mo, and 12-24 mo). Fibrinogen levels correlated with modified thromboelastogram MAs only in the 12-24 mo group. In this 12-24 mo age group other correlations between fibrinogen levels and thromboelastogram variables influenced by fibrinogen also became significant, as did correlations noted in adults between platelet counts and thromboelastogram variables. We conclude that the fibrinogen of children <12 mo old with congenital heart disease is qualitatively dysfunctional.
