Intraoperative fresh-frozen plasma versus human albumin in craniofacial surgery − A pilot study comparing coagulation profiles in infants younger than 12 months

Bert Hildebrandt; Andreas Machotta; Hanno Riess; Sabine Kerner; Olaf Ahlers; Hannes Haberl; Bernd Dörken; Thoralf Kerner

doi:10.1160/TH06-08-0475

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2007; 98(01): 172-177
DOI: 10.1160/TH06-08-0475

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Intraoperative fresh-frozen plasma versus human albumin in craniofacial surgery − A pilot study comparing coagulation profiles in infants younger than 12 months

Bert Hildebrandt

¹Charité Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie

,

Andreas Machotta

²Charité Centrum für Anästhesiologie, OP-Management und Intensivmedizin, Kliniken für Anästhesiologie und operative Intensivmedizin

,

Hanno Riess

¹Charité Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie

,

Sabine Kerner

³Charité Centrum für Frauen-, Kinder-, und Jugendmedizin, Klinik für Kinderchirurgie

,

Olaf Ahlers

²Charité Centrum für Anästhesiologie, OP-Management und Intensivmedizin, Kliniken für Anästhesiologie und operative Intensivmedizin

,

Hannes Haberl

⁴Charité Centrum für Neurologie, Neurochirurgie, und Psychiatrie, Arbeitsbereich Pädiatrische Neurochirurgie; Charité-Universitätsmedizin Berlin, Berlin, Germany

,

Bernd Dörken

¹Charité Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie

,

Thoralf Kerner

²Charité Centrum für Anästhesiologie, OP-Management und Intensivmedizin, Kliniken für Anästhesiologie und operative Intensivmedizin

› Institutsangaben

Abstract

Summary

The transfusion of fresh-frozen plasma (FFP) is suggested to minimize dilution coagulopathy when applied instead of colloids during paediatric craniofacial surgery (pCFS). We prospectively compared plasmatic haemostaseologic function between volume replacement with FFPs versus human albumin (HA) in a pilot study. Thirty infants with primary craniosynostosis were scheduled for pCFS. In 15 of those, FFPs were available from the identical donor as for packed red blood cells (pRBC), and were thus employed for intraoperative volume replacement. The remaining 15 infants were infused with HA-5% instead. Haemoglobin (Hb)-values, global coagulation parameters (activated partial thromboplastin time-aPTT; prothrombin time-PT), selected clotting factors (F) (VIII, XI, XIII), antithrombin-AT, fibrinolytic factors (fibrinogen; plasminogen; alpha2-antiplasmin-α2A), and activation parameters (thrombin-antithrombin-complex-TAT; plasmin-antiplasmin-complex-PAP; D-dimers) were assessed and compared between both groups after induction of anaesthesia, before transfusion of pRBC, and at the end of surgery. Patients and treatment characteristics were balanced between both groups. Prolongation of aPTT and decreases of PT, FXI, FXIII, AT3, and fibrinolytic factors were more pronounced in the HA-group. Increases in F VIII activity, activation parameters, and the course of Hb-values were similar among both groups. There was no difference regarding clinical endpoints (peri-/postoperative pRBC-transfusions, postoperative blood loss). In conclusion, the application of HA was associated with a more distinct dilution of procoagulant factors, AT3, and fibrinolytic factors than the use of FFPs. However, the course of activation markers suggested a similar extent of clotting and fibrinolytic activation with the use of both transfusion regimens, and there were no differences with regard to clinical endpoints.

Keywords

Craniosynostosis - perioperative care - red blood cell transfusion - blood coagulation factors - fibrinolysis - blood coagulation disorders

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Referenzen

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