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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 379-388, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
P Zilla, R Fasol, P Groscurth, W Klepetko, H Reichenspurner and E Wolner
The ultrastructure of blood platelets was related to platelet function and
secretion products before, during, and after cardiopulmonary bypass.
Circulating platelets from 15 patients undergoing aorta- coronary bypass
operations were investigated at ten predetermined points of time by
scanning and transmission electron microscopy. Simultaneously, platelet
adenosine triphosphate, diphosphate, and serotonin, as well as plasma
levels of platelet factor 4, beta- thromboglobulin, serotonin, thromboxane
B2, lactic dehydrogenase, and free hemoglobin were measured. Moreover,
platelet responsiveness toward adenosine diphosphate and collagen was
determined by optical aggregometry. By scanning electron microscopy, the
number of unactivated platelets dropped from 96% +/- 4% to 54% +/- 19% (p
less than 0.05) 8 minutes after the onset of bypass. Simultaneously, the
percentage of "shape changed" platelets significantly increased. No major
release reaction was detected at this time. After the initial activation,
platelet morphology began to recover although the bypass continued. During
the late period of bypass, a highly significant correlation between
increasing plasma levels of alpha-granule compounds (platelet factor 4 and
beta-thromboglobulin) and lysis parameters (lactic dehydrogenase and free
hemoglobin) was found. However, transmission electron microscopic analysis
of the arterial filter and scanning electron microscopic findings of
circulating platelets indicated that the release products in plasma were
due not only to platelet lysis but also to a limited extent to secondary
aggregation. In an inverse and probably causative manner, platelet
morphology recovered, whereas the sensitivity of platelets to adenosine
diphosphate and collagen decreased toward the end of bypass.
ARTICLES
Blood platelets in cardiopulmonary bypass operations. Recovery occurs after initial stimulation, rather than continual activation
Second Department of Surgery, University of Vienna, Austria.
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