CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 74 AFRICA The role of immature platelet count and immature platelet fraction in determining the need for transfusion in patients undergoing CABG Cihan Yücel, Serkan Ketenciler, Hüseyin Gemalmaz, Nihan Kayalar Abstract Background: Platelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis to prevent excessive bleeding in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to evaluate the postoperative change in IP count (IPC), IP fraction (IPF) and mean platelet volume (MPV), a nd to examine their relationship with postoperative bleeding and blood transfusion. Methods: One hundred and forty-nine consecutive patients undergoing elective CABG were included in this prospective study. All CABGs were performed by the same surgical team in a standardised method, utilising the on-pump technique. IPC, MPV and IPF were measured pre-operatively, after the completion of surgery, and at the postoperative first, third and fifth days. The primary outcome measure of this study was whether the need for transfusion was associated with IP, IPF, MPV and platelet count. Results: There was a significant decrease of 7.77% in IPC on the day of the operation. Pre-operative IPC and IPF were correlated with postoperative drainage (p < 0.001), intraoperative blood transfusion (p < 0.001) and intensive care unit blood transfusion (p < 0.001). Pre-operative haemoglobin levels were significantly correlated with length of hospital stay. However, neither pre-operative IPC nor IPF were associated with length of hospital stay. Postoperative IPC was however associated with the length of hospital and intensive care unit stay (p = 0.008 and p = 0.009, respectively). Conclusion: Pre-operative IPC and IPF were significantly correlated with postoperative drainage and blood transfusion frequency. In patients undergoing CABG, these can be seen as serious guiding parameters in the estimation of postoperative bleeding. Keywords: coronary artery bypass grafting, platelets, immature platelet fraction, bleeding, transfusion Submitted 9/7/21, accepted 26/8/21 Published online 20/9/21 Cardiovasc J Afr 2022; 33: 74–78 www.cvja.co.za DOI: 10.5830/CVJA-2021-041 The coronary artery bypass graft (CABG) procedure is among the most common cardiac surgical procedures.1,2 It has become the final treatment to reduce symptoms and mortality rate in subjects with ischaemic heart disease resulting from multivessel coronary artery disease or left main artery disease for over 40 years.3 Thrombocytopaenia develops during cardiopulmonary bypass due to dilution of the blood, adhesion of platelets to non-thrombogenic surfaces and aggregation. Bleeding, which may develop as a result of this, poses a significant risk for CABG in terms of hospital mortality. Consumption of coagulation factors and impaired platelet function are responsible for about half of the postoperative bleeds and re-explorations following CABG.4 The need for blood transfusion as a result of excessive bleeding prolongs the hospital stay and increases healthcare costs, in addition to the increase in in-hospital mortality rate. The number of immature platelets (IP) and immature platelet fraction (IPF) may provide clues concerning the status of platelet function. IP are young cells that have recently been released into the circulation, and are considered indicators of bone marrow recovery.5 Newly released platelets from the bone marrow (immature or reticulated platelets) are larger, more physiologically active, contain more RNA than mature platelets and produce more thrombogenic activity. The IP count (IPC) and IPF values may be used as a representation of the number of recently produced platelets released into the circulation by regenerated bone marrow megakaryocytes, thereby reflecting the level of thrombopoiesis.6 Platelet dysfunction has been shown to play a role in postoperative bleeding, however, there are very little data pertaining to the role of these immature thrombocytes in the induction of sufficient homeostasis and the prevention of excessive bleeding following CABG. The purpose of this study was to investigate IPC, IPF and mean platelet volume (MPV) levels throughout the hospitalisation of patients undergoing CABG in order to elucidate whether they were associated with postoperative bleeding and the need for transfusion. Methods One hundred and forty-nine consecutive patients who underwent elective CABG in the Okmeydanı Training andResearchHospital were included in this prospective study. Subjects with a history of bleeding diathesis or abnormal pre-operative coagulation test results [international normalised ratio (INR) ≥ 1.3, activated partial thromboplastin time > 40 s] and those with chronic liver disease were excluded. Subjects scheduled for re-operation, and those in whom postoperative haemodynamic support with intraOkmeydani Training and Research Hospital, Istanbul, Turkey Cihan Yücel, MD, cihanyucell@hotmail.com Serkan Ketenciler, MD Hüseyin Gemalmaz, MD Nihan Kayalar, MD
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