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Microfluidics in Assessing Platelet Function

Microfluidics in Assessing Platelet Function

Published on: November 8, 2024

Hemostatic efficacy of pathogen-reduced platelets in children undergoing cardiopulmonary bypass

Sophia Hsien¹, Jeffrey D Dayton², Dennis Chen³

¹Department of Pediatrics, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA.

|December 14, 2021

Insights

Pathogen-reduction (PR) platelets did not increase blood loss or transfusion needs in pediatric patients after cardiopulmonary bypass (CPB). This suggests PR platelets offer safe hemostasis and reduced contamination risk in this population.

Area of Science:

Pediatric critical care medicine
Hematology
Transfusion medicine

Background:

Pediatric patients undergoing cardiopulmonary bypass (CPB) often require blood transfusions.
Pathogen-reduction (PR) of platelets lowers microbial contamination risk, but its impact on hemostatic efficacy in children is not well understood.

Purpose of the Study:

To evaluate the hemostatic efficacy of PR platelets in pediatric patients undergoing CPB.
To compare postoperative bleeding outcomes between standard and PR platelet transfusions.

Main Methods:

Retrospective chart review of pediatric patients following CPB surgery (2015-2019).
Comparison of demographic data, surgical complexity (RACHS score), and blood product usage.
Primary outcome: postoperative chest tube bleeding.

Main Results:

140 patients were analyzed; 26% received PR platelets, 74% received standard platelets.
No significant differences in age, sex, or RACHS score between groups.
Median chest tube output at 1, 2, 4, 8, and 24 hours post-surgery was similar for both standard and PR platelet groups.

Conclusions:

PR platelets did not result in increased blood loss or transfusion requirements compared to standard platelets.
PR platelets appear to provide acceptable hemostasis in pediatric CPB patients.
PR platelets offer a potential safety benefit by reducing microbial contamination risk.

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Abstract

Background:

Pediatric patients undergoing cardiopulmonary bypass (CPB) often require blood component transfusions. Pathogen-reduction (PR) of platelets reduces the risk of microbial contamination; however, its effect on hemostatic efficacy in this population is unclear. This study sought to characterize the hemostatic efficacy of PR platelets in children undergoing CPB.

Study Design And Methods:

We performed a retrospective chart review of patients admitted to a pediatric intensive care unit following CPB surgery from 2015 to 2019. Demographic data, validated scoring of repair complexity, products received, and outcomes were compared. The primary outcome was postoperative chest tube bleeding.

Results:

A total of 140 patients were enrolled. The majority of surgeries (124/140) were Risk Adjustment for Congenital Heart Surgery (RACHS) 1-3 repairs. Seventy-four percent of patients (104/140) received only standard platelets whereas 26% (36/140) received PR platelets. There were no differences between the groups in the age (p = .90), sex (p = .20) or RACHS score (p = .06). Postoperatively, there was no difference in the median chest tube output for 1 h (p = .27), 2 h (p = .26), 4 h (p = .09), 8 h (p = .16), or for the first 24 h following surgery (p = .23) in patients who received standard versus PR platelets. There was also no difference in receipt of platelets (p = .18), cell saver (p = .79), or cryoprecipitate (p = .28).

Conclusion:

Patients receiving PR platelets did not have more blood loss or require more transfusions than those who received standard platelets. This suggests that PR platelets may provide acceptable hemostasis with the additional benefits of reduced risk of microbial contamination in pediatric patients undergoing CPB.

Keywords:

bleeding cardiopulmonary bypass children congenital heart disease critical illness hemostasis pathogen reduction platelet transfusion

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