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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 530-534, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
R Mohr, U Martinowitz, J Lavee, D Amroch, B Ramot and DA Goor
The major cause of nonsurgical bleeding after cardiopulmonary bypass is
delayed recovery of platelet count and function. Recovery of platelet count
and function was compared in 27 patients who were randomized preoperatively
to receive after cardiopulmonary bypass either 1 unit of fresh whole blood
(15 patients) or 10 units of platelet concentrates (12 patients). Platelet
count, bleeding time, platelet aggregation (adenosine diphosphate,
collagen, epinephrine, and ristocetin) and platelet thromboxane formation
were abnormal after cardiopulmonary bypass in all the patients. The
increase of platelet count after 1 unit of fresh whole blood (from 115 +/-
32 X 10(9)/L to 148.5 +/- 36 X 10(9)/L) was similar to that achieved by 4
units of platelets (from 140 +/- 61 X 10(9)/L to 171 +/- 60 X 10(9)/L). The
increase was doubled after 10 platelet units (from 140 +/- 61 X 10(9)/L to
209 +/- 55 X 10(9)/L). Bleeding time returned to normal values after fresh
whole blood or after 8 platelet units. However, platelet thromboxane
formation was higher after 1 unit of fresh whole blood than after 10
platelet units (95 +/- 25 versus 46 +/- 35 ng/ml, p less than 0.05), as was
platelet aggregation response to collagen and epinephrine. The 24- hour
blood loss was smaller in the fresh whole blood group (560 +/- 420 ml
versus 770 +/- 360 ml), although the difference was not statistically
significant. The results suggest that the hemostatic effect of 1 unit fresh
whole blood after cardiopulmonary bypass is at least equal, if not
superior, to the effect of 10 units of platelets.
ARTICLES
The hemostatic effect of transfusing fresh whole blood versus platelet concentrates after cardiac operations
Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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