PB0482 - Dysfunctional Hemostasis in Patients under Extracorporeal Life Support. A Rapid Diagnostic Approach with Therapeutical Guidance Intentions

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Ana Belén Moreno-Castaño, MD

Medical Doctor
Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Barcelona, Catalonia, Spain

Co-Author(s)

ES

Elena Sandoval

Medical Doctor
Hospital Clinic Barcelona
Barcelona, Catalonia, Spain
MP

Marc Pino

Laboratory Technician
Hemostasis and Erythropatology Laboratory, Pathology Department, CDB
Barcelona, Catalonia, Spain
SS

Sahar Samanbar

Technical Research Assistant
Hematopathology, Pathology Department, CDB, Hospital Clinic, IDIBAPS, University of Barcelona, Spain
Barcelona, Catalonia, Spain
LB

Laura Bonastre

Laboratory Technician
Hospital Clinic Barcelona
Barcelona, Catalonia, Spain
PM

Patricia Molina

Laboratory Technician
Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Centre Diagnòstic Biomèdic (CDB), Hospital Clínic, Barcelona, Spain
Barcelona, Catalonia, Spain
SF

Sara Fernandez

MD
Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.
Barcelona, Catalonia, Spain
HV

Helena Ventosa-Capell

MD, PhD Student
Hematopathology, Department of Pathology, Centre de Diagnostic Biomedic (CDB), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
Barcelona, Catalonia, Spain
GE

Gines Escolar

MD PhD Senior Consultant
Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Barcelona, Catalonia, Spain
PC

Pedro Castro

MD, PhD
Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.
Barcelona, Catalonia, Spain
Maribel Diaz-Ricart, PhD

Senior Researcher
Hospital Clinic, IDIBAPS, University of Barcelona, Spain
Barcelona, Catalonia, Spain

Background: Short-term cardiopulmonary extracorporeal life supports (ECLS) are invasive devices whose use has increased exponentially during the COVID-19 pandemic. Major bleeding is a main cause of morbi-mortality in ECLS patients and acquired von Willebrand disease (aVWD) could justify this complication.

Aims: We aim at investigating the primary hemostasis alterations profile in ECLS patients, and to propose a potential treatment if bleeding.

Methods: Patients in ECLS at our center since June 2021 were included (n=25). Primary hemostasis was evaluated by: von Willebrand Factor antigen (VWF:Ag) and activity (VWF:GPIbM) measurement (immunoturbidimetry), VWF multimeric analysis (agarose-gels and immunoblotting), platelet function analysis (PFA-200), and platelet activation (CD62P and CD63 expression by flow cytometry). Studies were performed 24h after implant, each 7 days, and in the first week after ECLS extraction. T-TAS® was used for hemostasis analysis in samples from bleeding patients, before and after in vitro addition of purified VWF. This study was approved by the Hospital Clinic’s Ethics Committee (HCB/2021/0200).

Results: After 24h of ECLS implant, increased VWF:Ag levels and prolonged PFA occlusion times. In 60% of patients, altered VWF:GPIbM/VWF:Ag ratio ( < 0.7) and loss of VWF high molecular weight multimers (HMWM) were observed. CD62P expression was slightly higher in ECLS patients platelets than in controls (MFI±SD of 4.34±2.2 vs. 3.27±0.6, respectively; p=0.3). Early after ECLS extraction, there was normalization of the VWF multimeric profile and PFA values. Interestingly, in samples from bleeding patients, addition of purified VWF reduced significantly the T-TAS occlusion times (776s±207s vs. 1161s±251s, Mean±SD, post vs. pre, respectively; p=0.033).

Conclusion(s): ECLS caused primary hemostasis alterations, leading to aVWD and platelet activation, solved early after support removal. Hemostatic efficiency in ECLS bleeding patients, with lack of HMWM, was corrected in vitro by providing functional purified VWF.