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The haematocrit--an important factor causing impaired haemostasis in patients with cyanotic congenital heart disease
A S Jensen1, P I Johansson, L Idorn
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. schophuus@gmail.com
Insights
Patients with cyanotic congenital heart disease (CCHD) experience bleeding risks due to abnormal blood clotting linked to high hematocrit. Reducing hematocrit through phlebotomy improved clotting and stopped bleeding in a study.
Area of Science:
- Cardiovascular Medicine
- Hematology
Background:
- Cyanotic congenital heart disease (CCHD) is associated with hemostatic abnormalities and increased bleeding risk.
- Elevated hematocrit (high red blood cell count) in CCHD patients is a potential cause of these bleeding issues.
Purpose of the Study:
- To characterize the hemostatic profile in CCHD patients.
- To examine the impact of hematocrit levels on the hemostatic profile.
- To determine if reducing hematocrit can effectively manage bleeding in CCHD patients.
Main Methods:
- A prospective, multicenter study involving 98 CCHD patients.
- Assessed hemostatic profile including hematocrit, platelet count, and thrombelastography (TEG).
- Evaluated effects of phlebotomy and iron supplementation on hematocrit and hemostasis; TEG analyzed clot formation and strength.
Main Results:
- CCHD patients with elevated hematocrit showed hypocoagulability (reduced clot formation and strength) via TEG.
- A positive correlation was observed between higher hematocrit levels and hypocoagulability.
- Phlebotomy and iron supplementation interventions confirmed the hematocrit-hemostasis correlation.
- Phlebotomy successfully terminated hemoptysis (bloody cough) in 10 CCHD patients.
Conclusions:
- Elevated hematocrit in CCHD patients contributes to a hypocoagulable state.
- Hematocrit reduction appears to improve hemostasis and may effectively control bleeding.
- Further research is warranted to confirm these findings and their clinical implications.
Background:
Patients with cyanotic congenital heart disease(CCHD) have haemostatic abnormalities, which result in an increased risk of bleeding. The cause is unknown, but recent studies have indicated that an elevated haematocrit, which is present in cyanotic patients, could be an important factor. The aim of this study was to characterize the haemostatic profile, examine how changes in haematocrit affect the haemostatic profile, and whether a haematocrit reduction could terminate bleeding in CCHD patients.
Methods:
This was a prospective, multicenter study. The haemostatic profile consisting of haematocrit, platelet count and thrombelastography(TEG) was characterized in ninety-eight CCHD patients. To evaluate the influence of haematocrit on the haemostatic profile, 21 of the patients underwent phlebotomy and 16 patients received treatment with an iron supplement. Furthermore ten patients with haemoptysis underwent phlebotomy. The haemostatic profile was reevaluated after interventions.
Results:
TEG revealed that patients with CCHD and elevated haematocrit were hypocoagulable due to reduced clot formation and strength. Furthermore a positive correlation between elevated haematocrit and hypocoagulability was present. Interventions such as phlebotomy and treatment with supplemental iron causing significant haematocrit changes confirmed the correlation between haematocrit and the haemostatic profile. Finally a haematocrit reduction by phlebotomy successfully terminated haemoptysis in ten CCHD patients.
Conclusion:
Patients with CCHD and elevated haematocrit are hypocoagulable. The hypocoagulable haemostatic profile is positively correlated to increasing haematocrit. An intervention, which increases or decreases haematocrit, changes the haemostatic profile. A haematocrit reduction seems to improve the haemostatic profile, and may thereby terminate bleeding. However, these results warrant further studies.
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