Ex-vivo response to blood products and haemostatic agents after paediatric cardiac surgery.

Bleeding complications after cardiac surgery are of particular importance in children because they are more prone to volume overload. To optimize haemostatic intervention, the coagulopathy has to be characterized, and knowledge about the effect of blood products and haemostatic agents is needed. The aims of the present study were to investigate changes in coagulation profiles after paediatric cardiac surgery and the effect after ex-vivo addition of blood products and haemostatic agents.

Fibrinogen concentrate and cryoprecipitate but not fresh frozen plasma correct low fibrinogen concentrations following in vitro haemodilution.

Introduction: Fibrinogen deficiency often develops during massive bleeding due to e.g. fluid resuscitation with colloid plasma expanders like hydroxyethyl starch.

Can RoTEM® analysis be applied for haemostatic monitoring in paediatric congenital heart surgery?

Background: Successful management of bleeding disorders after congenital heart surgery requires detection of specific coagulation disturbances. Whole-blood rotation thromboelastometry (RoTEM®) provides continuous qualitative haemostatic profiles, and the technique has shown promising results in adult cardiac surgery.

Setting: To compare the performance of RoTEM® with that of conventional coagulation tests in children, we conducted a descriptive study in children undergoing congenital cardiac surgery.

Diagnostic performance and therapeutic consequence of thromboelastometry activated by kaolin versus a panel of specific reagents.

Background: Thromboelastography/metry (TEG®; Haemoscope, Niles, IL/ROTEM®; Tem International GmbH, Munich, Germany) is increasingly used to guide transfusion therapy. This study investigated the diagnostic performance and therapeutic consequence of using kaolin-activated whole blood compared with a panel of specific TEM®-reagents to distinguish: dilutional coagulopathy, thrombocytopenia, hyperfibrinolysis, and heparinization.

Methods: Blood was drawn from 11 healthy volunteers.

Evaluation of coagulation kinetics using thromboelastometry-methodologic influence of activator and test medium.

Renewed interest has arisen in the use of thromboelastography/thromboelastometry in evaluating coagulation kinetics. The test medium, type of activator, and its concentration may influence the interpretation of coagulation kinetics. This study aimed to investigate methodologic influences of activator and test medium on thromboelastometric parameters of coagulation kinetics.

Thrombin generation and coagulation factor activities: evaluation and comparison with the international normalized ratio.

Oral anticoagulation therapy is monitored effectively by the international normalized ratio (INR). However, INR is perhaps not optimal in predicting risk of complications. Other more sensitive methods have been suggested.

Hyperhomocysteinemia due to folate deficiency is thrombogenic in rats.

Although hyperhomocysteinemia (HH) appears to be an independent risk factor for thrombosis, the pathophysiologic mechanisms seen in thrombus formation are largely unresolved. The aim of the present study was to investigate whether HH is accompanied by thrombogenic alterations as assessed by whole blood thromboelastographic profiles. Severe (111 micro mol/L) and intermediate (42 micro mol/L) HH were induced in two series of rats by feeding them a folate-depleted diet.

Antibodies to heterologous proteins in hemophilia A patients receiving recombinant factor VIII (Recombinate).

As a consequence of the manufacturing process, trace quantities of Chinese hamster ovary cell protein, bovine serum albumin and murine immunoglobulin G are present in Recombinate recombinant human factor VIII (rhFVIII). The development of antibodies (Abs) to these heterologous proteins was evaluated during long-term rhFVIII therapy of hemophilia A in 68 previously treated and 73 previously untreated patients. Ab prevalence was also assessed in 157 non-hemophilic subjects.