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Updated: Apr 23, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Preoperative platelet dysfunction predicts blood product transfusion in children undergoing cardiac surgery
M Mujeeb Zubair1, David K Bailly2, Gurion Lantz1
1Division of Pediatric Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Insights
Preoperative platelet dysfunction, indicated by prolonged closure time (CT), increases the likelihood of blood product transfusions in children undergoing cardiac surgery. This finding is crucial for optimizing blood product management and patient care.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Pediatric Medicine
Background:
- Excessive bleeding is a significant complication in pediatric cardiac surgery.
- Both cardiopulmonary bypass-induced and preoperative platelet dysfunction can contribute to coagulopathy and bleeding.
- Understanding preoperative platelet function is vital for predicting transfusion needs.
Purpose of the Study:
- To investigate the association between preoperative platelet dysfunction and the requirement for blood product transfusions in children undergoing cardiac surgery.
- To determine if preoperative platelet function predicts transfusion needs in this patient population.
Main Methods:
- A cohort of 338 children undergoing cardiac surgery with cardiopulmonary bypass between 2008 and 2012 was studied.
- Platelet function was assessed using the platelet function analyzer test, measuring closure time (CT).
- Linear and logistic regression analyses were used to correlate closure time with red blood cell and fresh-frozen plasma transfusion volumes.
Main Results:
- Patients with prolonged closure time (indicating platelet dysfunction) had significantly higher odds of receiving red blood cell and fresh-frozen plasma transfusions.
- Univariate analysis identified age, weight, hematocrit, cardiopulmonary bypass time, and closure time as associated with transfusion needs.
- Multivariable regression confirmed that age, cardiopulmonary bypass time, and closure time were significant independent predictors of transfusion requirements.
Conclusions:
- Prolonged preoperative closure time is a significant predictor of increased red blood cell and fresh-frozen plasma transfusion in children undergoing cardiac surgery, even after accounting for age and cardiopulmonary bypass time.
- These findings highlight the importance of preoperative platelet function assessment for anticipating and managing blood product utilization.
- The results have implications for improving the planning and allocation of blood products in pediatric cardiac surgery.
Objectives:
Excessive bleeding can be a problem during or after cardiac surgery. While cardiopulmonary bypass-associated platelet dysfunction is an important inducer of coagulopathy, preoperative platelet dysfunction can also contribute to this bleeding. We investigated the relationship between preoperative platelet dysfunction and transfusion of blood products given to children undergoing cardiac surgery.
Methods:
The platelet function analyser test measures platelet function in vitro by aspirating blood through a small standard hole (creating high shear) in a collagen membrane infused with a platelet agonist. The time taken to form a platelet plug is known as closure time and prolonged closure time (CT) indicates platelet dysfunction. Three hundred and thirty-eight children who had undergone surgery with cardiopulmonary bypass between 2008 and 2012 were included. The volume of red blood cells and fresh-frozen plasma transfused was recorded. The relationship between closure time and transfusion requirements was analysed using linear and logistic regression.
Results:
Patients with prolonged closure time had greater odds of getting red blood cells and fresh-frozen plasma transfusions compared with patients with normal closure time (P <0.01). On univariate analysis, age, weight, haematocrit, cardiopulmonary bypass time, Risk Adjustment for Congenital Heart Surgery score and closure time were associated with increased odds of red blood cells and fresh-frozen plasma transfusion in the operation theatre (P <0.05). However, when logistic multivariable regression analysis was applied, only age, cardiopulmonary bypass time and closure time remained as significant predictive factors for transfusion.
Conclusions:
In children who have undergone cardiac surgery, when age and cardiopulmonary bypass time are accounted for, a prolonged preoperative closure time is significantly associated with increased odds of red blood cells and fresh-frozen plasma transfusion in the operation theatre. This may have implications for planning and utilization of blood products.
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