Fibrin Network Changes in Neonates after Cardiopulmonary Bypass

• Type of Material: Article
• Authors: Ashley C. Brown, North Carolina State University; Riley Hannan, Georgia Institute of Technology; Lucas Timmins, Emory University; Janet D. Fernandez, Emory University; Thomas Barker, Emory University; Nina Guzzetta, Emory University
• Language: English
• Date: 2016-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1097/ALN.0000000000001058
• Title of Journal or Parent Work: Anesthesiology
• ISSN: 0003-3022
• Volume: 124
• Issue: 5
• Start Page: 1021
• End Page: 1031
• Grant/Funding Information: Sources of financial support: Emory University and Children’s Healthcare of Atlanta: Children’s Center for Cardiovascular Biology; National Institutes of Health R21EB019068
• Keywords: BLOOD; THROMBIN; HUMAN COAGULATION SYSTEM; OUTCOMES; INFANT; Anesthesiology; CHILDREN; Life Sciences & Biomedicine; PEDIATRIC CARDIAC-SURGERY; TRANSFUSION; Science & Technology; HEMOSTASIS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

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.