Management of Microvascular Bleeding after On-Pump Cardiac Surgery in a Patient with Perioperative Diagnosis of Impairment of Platelet Responses to Adenosine Diphosphate: A Case Report and a Literature Review

Figures

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  Figure 1. Results of the baseline preoperative functional platelet assay with (a) thrombin-activated peptide-6 (TRAP), (b) arachidonic acid (ASPI), and (c) adenosine diphosphate (ADP) tests using multiple electrode aggregometry (MEA, Multiplate® Roche Diagnostics). The normal reference interval for the TRAP, ASPI, and ADP tests is represented by the darker green field above the X-axis. If in the darker fields, the black dash indicates normal platelet function. On the contrary, if the black dash falls beneath, it indicates impaired platelet function. Blue and red curves result from the test sample being analyzed in each test cell using two independent sensors. The difference should not exceed 15%. All tests were within this variation.

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  Figure 2. Results of the intraoperative functional platelet assay with (a) TRAP, (b) ASPI, and (c) ADP tests following weaning from CPB using MEA (Multiplate® Roche Diagnostics). The normal reference interval for the TRAP, ASPI, and ADP tests is represented by the darker green field above the X-axis. If in the darker fields, the black dash indicates normal platelet function. On the contrary, if the black dash falls beneath, it indicates impaired platelet function. Blue and red curves result from the test sample being analyzed in each test cell using two independent sensors. The difference should not exceed 15%. All tests were within this variation.

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  Figure 3. Results of the intraoperative functional platelet assay with (a) TRAP, (b) ASPI, and (c) ADP tests following intravenous infusion of desmopressin 0.3 μg/kg body weight using MEA (Multiplate® Roche Diagnostics). The normal reference interval for the TRAP, ASPI, and ADP tests is represented by the darker green field above the X-axis. If in the darker fields, the black dash indicates normal platelet function. On the contrary, if the black dash falls beneath, it indicates impaired platelet function. Blue and red curves result from the test sample being analyzed in each test cell using two independent sensors. The difference should not exceed 15%. All tests were within this variation.

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  Figure 4. Flow diagram of studies’ selection.