Cyanotic disease is an independent predictor of FFP and platelet transfusion in cardiac surgery children
P. Patte, A. Willems, D. Datoussaid and P. Van Der Linden
Introduction
Cyanotic disease is associated with altered platelet function and low fibrinogen level that could increase the risk of bleeding and therefore the exposure to blood products (1).
Material and methods
This retrospective observational study was conducted in a tertiary children hospital from 2002 to 2014. Patients who received fresh frozen plasma (FFP) in CPB priming were excluded. Anaesthesia, cardiopulmonary bypass (CPB) and surgery were standardized. Transfusion of red blood cell (RBC), FFP and platelets were compared between acyanotic and cyanotic patients. Multivariate analysis was used to determine if a cyanotic heart disease predicted the transfusion of FFP or platelets.
Results
From the 2113 patients included in the study, 267 were excluded, leaving 1846 patients for analysis, with 1063 patients in the acyanotic and 783 patients in the cyanotic cardiopathy group. Overall, children in the cyanotic group were younger, had a lower weight, a higher ASA and RACHS-1 scores, a higher priming volume, a higher intra-operative fluid balance and longer surgery, CPB and aortic cross clamp times. Preoperatively, children in the cyanotic group had lower platelet count (291.0 vs 328.5 x10³/ml) and fibrinogen level (270.0 vs 285.0 mg/dL) and higher INR (1.1 vs 1.0). RBC were less frequently added in the CPB prime and transfused in the cyanotic group but blood loss was significantly higher. Overall, more children in the cyanotic group received FFP and platelets transfusions. The presence of a cyanotic cardiopathy was an independent predictor of FFP (OR: 2.08 and 95% CI: 1.44 to 3.01) and platelet transfusion (OR: 3.90 and CI: 2.27 to 6.69).
	Acyanotic group	Cyanotic group	P-value
Blood loss			
Intraoperative blood loss (ml kg-1)	26.7 (14.8-44.7)	31.1 (17.6-50.4)	<0.001
Chest tube drainage (total) (ml kg-1)	16.9 (10.4-26.9)	31.2 (19.1-51.9)	<0.001
Transfusions			
RBC in priming	594 (56.1%)	304 (39.1%)	<0.001
RBC	689 (65.0%)	451 (57.8%)	0.002
FFP	61 (5.7%)	169 (21.6%)	<0.001
Platelet	23 (2.2%)	102 (13.0%)	<0.001
Conclusion
Children with a cyanotic heart disease have an increased risk to be exposed to FFP and platelet transfusion in the perioperative period of cardiac surgery.
(1)	Tempe DK, Virmani S. Coagulation Abnormalities In Patients With Cyanotic Congenital Heart Disease. J Cardiothorac Vasc Anesth. 2002;16:752-65

Cyanotic disease is an independent predictor of FFP and platelets transfusion in cardiac surgery children