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
