Platelet Function During ECMO (Extra Corporeal Membrane Oxygenation)
| Status: | Completed |
|---|---|
| Conditions: | Hematology |
| Therapuetic Areas: | Hematology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 11/18/2012 |
| Start Date: | June 2008 |
| End Date: | December 2013 |
| Contact: | Karen Osborne |
| Email: | karen.osborne@hsc.utah.edu |
| Phone: | 801-587-7502 |
Platelet Function During ECMO
Platelet transfusions are routinely administered during neonatal ECMO, with an average of
1.3 platelet transfusions per day being administered while a patient is undergoing ECMO
treatment. The cause of thrombocytopenia during ECMO largely involves platelet adherence to
the oxygenator membrane. Platelet transfusions carry risks such as infections with bacteria
or yeast, and development or worsening of pulmonary hypertension. It is likely that if fewer
platelet transfusions can be administered during the ECMO run, the cumulative adverse
effects of platelet transfusions would diminish and patient outcomes improve. In order to
better understand platelet function during ECMO, the investigators plan to serially
determine the circulating platelet mass, plasma platelet factor 4 concentration,
megakaryocyte mass (estimated by plasma thrombopoietin concentration), and platelet function
as quantified by PFA100. Any patient on ECMO will be eligible for this pilot study of 5
patients. By understanding changes in platelet function, we hope to design a future study
that may modify the frequency or need for platelet transfusions during ECMO.
Platelet transfusions are routinely administered during neonatal ECMO, with an average of
1.3 platelet transfusions per day being administered while a patient is undergoing ECMO
treatment.1 In general, a platelet transfusion is ordered for a patient on ECMO if the
platelet count falls below 100,000/uL in order to prevent generalized hemorrhaging.1,2 The
cause of thrombocytopenia during ECMO largely involves platelet adherence to the oxygenator
membrane,3 but other mechanisms are also likely to be involved.4 Platelet transfusions carry
risks as well as benefits.5 Infections with bacteria or yeast are the most commonly
reported complications of platelet transfusions,6,7 but with multiple platelet transfusions
the development or worsening of pulmonary hypertension may be another common adverse
effect.8,9 Pulmonary hypertension can be the result of administering biologically active
pro-inflammatory proteins (known to be present in platelet transfusions) into the venous
circulation. Of note, the first capillary bed encountered will be within the pulmonary
circulation.
It is likely that if fewer platelet transfusions could safely be administered during the
ECMO run, the cumulative adverse effects of platelet transfusions would diminish and thereby
patient outcomes might improve.
Inclusion Criteria:
- Any patient on ECMO will be eligible for study.
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