Postoperative bypass bleeding: a bypass-associated dilutional (BAD) coagulopathy?

Blood Cells Mol Dis. 2009 Nov-Dec;43(3):256-9. doi: 10.1016/j.bcmd.2009.07.002. Epub 2009 Aug 21.

Abstract

A number of associations with post-bypass bleeding have been described in the accompanying paper. Herein we hypothesize that dilution is an underlying cause through a malign series of bypass-associated events. Heparinized blood behaves anomalously when diluted. Clotting times first shorten somewhat, then--as the dilution of whole blood approaches 50%--rapidly lengthen to unclottability. During cardiopulmonary bypass, low blood volume patients are at a significant risk of clotting factor dilution which will always be more severe than the level of whole blood dilution. If severe enough, this dilution may lower plasma clotting factors to a critical level and may result in excess protamine administration, secondary to overestimation of heparin. The presence of un-neutralized protamine combined with critically lowered clotting factors leads to marked coagulopathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation Factors / analysis
  • Blood Coagulation Factors / metabolism*
  • Cardiopulmonary Bypass*
  • Heparin / blood
  • Humans
  • Postoperative Hemorrhage / etiology*
  • Protamines / blood
  • Sex Factors
  • Transfusion Reaction*

Substances

  • Blood Coagulation Factors
  • Protamines
  • Heparin