Despotis et al reported the conditions associated with causes for bleeding associated with cardiopulmonary bypass (CPB). The authors are from Washington University in St. Louis.

Patient selection: cardiopulmonary bypass


Hemostatic abnormalities associated with cardiopulmonary bypass:

(1) consumption of coagulation factors

(2) heparin-related anticoagulation

(3) thrombocytopenia (blood loss, consumption, etc)

(4) platelet activation and/or changes in platelet function (due to decreased reactivity, degranulation, loss of glycoprotein receptors, etc)

(5) heparin-induced thrombocytopenia

(6) protamine-related platelet dysfunction

(7) disseminated intravascular coagulation (DIC)

(8) excess fibrinolysis and/or deficiency of inhibitors to fibrinolysis

(9) effects of hypothermia


Laboratory manifestations:

(1) prolongation of PT, INR and PTT

(2) decrease in coagulation factors, including hypofibrinogenemia

(3) prolonged bleeding time

(4) fall in platelet count

(5) platelet dysfunction

(6) positive fibrin split products

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