Perioperative Medicine  |   May 2016
Fibrin Network Changes in Neonates after Cardiopulmonary Bypass
Author Notes
  • From the Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, North Carolina (A.C.B.); The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia (R.H., L.H.T., T.H.B.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (L.H.T.); and Department of Anesthesiology, Emory University School of Medicine, Children’s Healthcare of Atlanta at Egleston, Atlanta, Georgia (J.D.F., N.A.G.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Presented at the 2014 American Society of Anesthesiologist Annual Meeting, New Orleans, Louisiana, October 14, 2014; 2014 Biomedical Engineering Society (BMES) Annual Meeting, San Antonio, Texas, October 25, 2014; and 2014 International Fibrinogen Workshop, Marseille, France, July 9, 2014.
    Presented at the 2014 American Society of Anesthesiologist Annual Meeting, New Orleans, Louisiana, October 14, 2014; 2014 Biomedical Engineering Society (BMES) Annual Meeting, San Antonio, Texas, October 25, 2014; and 2014 International Fibrinogen Workshop, Marseille, France, July 9, 2014.×
  • Submitted for publication June 26, 2015. Accepted for publication January 27, 2016.
    Submitted for publication June 26, 2015. Accepted for publication January 27, 2016.×
  • Address correspondence to Dr. Guzzetta: Department of Anesthesiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, 1364 Clifton Rd NE, Atlanta, Georgia 30332. nguzzet@emory.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Coagulation and Transfusion / Pediatric Anesthesia
Perioperative Medicine   |   May 2016
Fibrin Network Changes in Neonates after Cardiopulmonary Bypass
Anesthesiology 5 2016, Vol.124, 1021-1031. doi:10.1097/ALN.0000000000001058
Anesthesiology 5 2016, Vol.124, 1021-1031. doi:10.1097/ALN.0000000000001058
Abstract

Background: Quantitative and qualitative differences in the hemostatic systems exist between neonates and adults, including the presence of “fetal” fibrinogen, a qualitatively dysfunctional form of fibrinogen that exists until 1 yr of age. The consequences of “fetal” fibrinogen on clot structure in neonates, particularly in the context of surgery-associated bleeding, have not been well characterized. Here, the authors examine the sequential changes in clotting components and resultant clot structure in a small sample of neonates undergoing cardiac surgery and cardiopulmonary bypass (CPB).

Methods: Blood samples were collected from neonates (n = 10) before surgery, immediately after CPB, and after the transfusion of cryoprecipitate (i.e., adult fibrinogen component). Clots were formed from patient samples or purified neonatal and adult fibrinogen. Clot structure was analyzed using confocal microscopy.

Results: Clots formed from plasma obtained after CPB and after transfusion were more porous than baseline clots. Analysis of clots formed from purified neonatal and adult fibrinogen demonstrated that at equivalent fibrinogen concentrations, neonatal clots lack three-dimensional structure, whereas adult clots were denser with significant three-dimensional structure. Clots formed from a combination of purified neonatal and adult fibrinogen were less homogenous than those formed from either purified adult or neonatal fibrinogen.

Conclusions: The results of this study confirm that significant differences exist in clot structure between neonates and adults and that neonatal and adult fibrinogen may not integrate well. These findings suggest that differential treatment strategies for neonates should be pursued to reduce the demonstrated morbidity of blood product transfusion.

Abstract

Clots formed from blood samples collected from 10 neonates after cardiopulmonary bypass were more porous than clots formed from samples collected before surgery. Clots formed from purified fibrinogen from neonates alone or mixed with adult fibrinogen were less dense than adult clots, suggesting that transfusion of adult fibrinogen may be less effective in neonates than in adults.

Supplemental Digital Content is available in the text.