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Measuring coagulopathy in pediatric craniofacial surgery
Alexandra J Borst1, Christopher M Bonfield2, Poornachanda S Deenadayalan3
1Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania.
Insights
Hematologic and coagulation tests can predict blood loss in pediatric complex cranial vault reconstruction (CCVR). However, these standard lab values offer limited insight into the specific mechanisms of coagulopathy during craniofacial surgery.
Area of Science:
- Pediatric Surgery
- Hematology
- Coagulation Science
Background:
- Complex cranial vault reconstruction (CCVR) for craniosynostosis is a major surgical procedure.
- Understanding factors predicting blood loss is crucial for patient management.
Conclusions:
- Standard hematologic and coagulation tests can predict blood loss in pediatric CCVR.
- These laboratory parameters provide limited mechanistic insight into coagulopathy in this surgical context.
- Further research may be needed to elucidate specific coagulopathic mechanisms in craniofacial surgery.
Abstract:
The goal of this study was to describe hematologic and coagulation laboratory parameters and identify if these laboratory studies could predict blood loss in a cohort of pediatric patients undergoing complex cranial vault reconstruction (CCVR) for repair of craniosynostosis. We reviewed records from 95 pediatric CCVR patients between 2015 and 2019. Primary outcome measures were hematologic and coagulation laboratory parameters. Secondary outcome measures were intraoperative and postoperative calculated blood loss (CBL). Preoperative laboratory values were within normal limits and did not predict outcomes. Intraoperative platelet count and fibrinogen predicted CBL but without clinically relevant thrombocytopenia or hypofibrinogenemia. Intraoperative prothrombin time (PT) and partial thromboplastin time (PTT) predicted perioperative CBL, possibly reflecting surgically induced coagulopathy. Postoperative laboratory values did not predict postoperative blood loss. We found that standard hematologic and coagulation laboratory parameters predicted intraoperative and postoperative blood loss but provided limited mechanistic information to improve our understanding of coagulopathy in craniofacial surgery.
