Point-of-care assessment of platelet aggregation in paediatric open heart surgery

Area of Science:

• Pediatric Cardiology
• Hematology
• Surgical Research

Background:

• Congenital heart disease (CHD) presents complex coagulation abnormalities.
• Platelet aggregability in children with acyanotic and cyanotic malformations undergoing open heart surgery requires further investigation.
• Whole-blood multiple electrode aggregometry (MEA) offers a rapid method for pediatric platelet analysis due to small sample volumes.

Purpose of the Study:

• To investigate the perioperative changes in platelet aggregation using MEA in children with CHD.
• To compare platelet aggregation between acyanotic and cyanotic malformations.
• To assess the relationship between platelet aggregation, blood loss, and transfusion requirements.

Main Methods:

• A prospective observational study included 50 children with acyanotic or cyanotic malformations.
• Platelet aggregation was measured using MEA with adenosine diphosphate (ADP), arachidonic acid, and thrombin receptor-activating peptide.
• Blood samples were collected pre-anesthesia, during surgery, and up to postoperative day 5. Surgical variables, bleeding, and transfusion data were recorded.

Main Results:

• Platelet counts were normal in all patients.
• Preoperative platelet aggregation was higher in cyanotic children compared to acyanotic children.
• Platelet aggregation significantly decreased during surgery in both groups, with slow recovery.
• The cyanotic group experienced greater bleeding and required more platelet transfusions, which correlated with ADP-induced aggregation.

Conclusions:

• Cyanotic patients exhibit higher blood loss and transfusion needs despite superior preoperative platelet aggregation.
• Multiple electrode aggregometry (MEA) alone may not be sufficient for predicting increased perioperative blood loss in pediatric CHD patients.