Abstract:
Introduction: In spite of the recent advances in
heart surgery, patients undergoing cardiac surgery
with cardiopulmonary bypass are at risk of developing
significant post-operative bleeding and substantial
blood requirements.
Objective: To evaluate the impact of some perioperative
predictors of post-operative bleeding,
and blood transfusion after heart surgery and offer
suggestions on preventive measures.
Design and Methods: A prospective analytical
study. The perioperative factors studied were haemoglobin
level, international normalised ratio
(INR), platelet count, and total bypass time.
Eighty-seven consecutive patients who underwent
heart surgery in the year 2004 were selected. Each
patient had laboratory work up which included full
blood count, clotting profile, kidney and liver
function tests. The total blood loss within the first
twenty-four hours and the total units of blood
transfused before the patient was discharged were
also recorded.
Results: Pre-operative haemoglobin was significant
in determining the total units of blood received
by a patient. Increasing total bypass time
caused a significant increase in the percentage
reduction of the pre-operative platelet count (p
<0.004). However even though there was an increasing
trend of post-operative bleeding with increase
in total bypass time, this was not significant
from the analysis (p<0.069). The percentage reduction
in platelet count and immediate postoperative
platelet count were significant predictors of
postoperative bleeding (p <0 .009) and (p <0.003)
respectively.
Conclusion: Pre-operative haemoglobin, percentage
reduction in the platelet count after cardiopulmonary
bypass and immediate postoperative platelet
count are significant predictors of postoperative
bleeding and blood requirements.