Abstract Number: PB0082
Meeting: ISTH 2021 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: Cardiopulmonary bypass (CPB) causes significant thrombotic complications despite aggressive anticoagulation, and postoperative hemorrhage remains a problematic morbidity. Growing evidence also suggests that pathologic complement activation predisposes to catastrophic microangiopathies in CPB. The effects of CPB on the hemostatic and complement systems in children have not been adequately studied, representing a critical knowledge gap.
Aims: Identify the changes in hemostasis and complement activation in children undergoing CPB.
Methods: IRB approval and informed consent were obtained prior to enrollment. Samples were prospectively collected at baseline, 5 minutes and 1 hour on CPB, at the end of CPB, and 24 hours postoperatively.
Results: 16 patients with mean age of 49.7 months (range 8 days to 17 years) were analyzed. Average CPB time was 160 minutes (range 59-407 minutes). We observed a statistically significant increase in VWF antigen and factor VIII shortly after bypass initiation (Fig. 1). We also observed statistically significant but modest diminutions in fibrinogen and factors II, VII, XI, XII and XIII after bypass initiation. We saw a major 10-fold diminution in factor V that far exceeded the changes we saw in other soluble clotting factors (Fig. 1). We also observed rapid and significant evidence of complement activation with CPB (increased C3a and sC5b-9) that resolved 24 hours following CPB (Fig. 2).
Conclusions: Pediatric patients undergoing CPB experienced multiple modifiable alterations in hemostasis and complement that may negatively impact outcomes. Specific correction of the major diminution in factor V may represent a novel way to prevent postoperative hemorrhage as factor V is diminished out of proportion to other factors in CPB. Elevations in VWF may contribute to postoperative thrombotic risk. Complement activation may predispose to microangiopathy and multisystem organ damage. As multiple agents targeting C5 and C3 exist or are in development, studies targeting complement activation in pediatric CPB would be of major clinical interest.
To cite this abstract in AMA style:
KT, Tweddell J, Jodele S, Mullins E, Palumbo J. Altered Hemostasis and Complement in Pediatric Patients Treated with Cardiopulmonary Bypass [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/altered-hemostasis-and-complement-in-pediatric-patients-treated-with-cardiopulmonary-bypass/. Accessed March 22, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/altered-hemostasis-and-complement-in-pediatric-patients-treated-with-cardiopulmonary-bypass/