Abstract
Red cell volume reduction corrected the platelet aggregation abnormality and bleeding tendency exhibited by 4 boys, ages 5 to 16, with severe cyanotic congenital heart disease and polycythemia (Hcts 68-75%). Red cell volume was lowered by replacing 15 to 20 ml/Kg of the patient's blood with plasma in 50 ml increments over a 1 to 2 hour period. Within 3 days, platelet aggregation was restored to normal, and previous bleeding symptoms disappeared. Platelet aggregation remained normal during 3 weeks of follow-up while hematocrits remained at palliative levels. The procedure was safe, simple, and produced beneficial effects not only on bleeding, but, also on other symptoms related to polycythemia and high blood viscosity.
The mechanism by which platelet function is corrected is not yet understood. In vitro studies showed no corrective effects of donor plasma on the abnormal platelets.
For polycythemic patients with cyanotic heart disease and platelet defects who require surgery, red cell volume reduction is recommended preoperatively to lessen the risk of serious bleeding during the early postoperative period. Palliation of severely cyanotic children who are inoperable is another indication for this procedure.
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Maurer, H., Mccue, C., Robertson, L. et al. CORRECTION OF PLATELET DYSFUNCTION AND BLEEDING IN CYANOTIC CONGENITAL HEART DISEASE BY SIMPLE RED CELL VOLUME REDUCTION. Pediatr Res 8, 406 (1974). https://doi.org/10.1203/00006450-197404000-00394
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DOI: https://doi.org/10.1203/00006450-197404000-00394