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Clotting Parameters and Thromboelastography in Children With Neuromuscular and Idiopathic Scoliosis Undergoing Posterior Spinal Fusion

Brenn, B Randall, MD*; Theroux, Mary C., MD*; Dabney, Kirk W., MD; Miller, Freeman, MD

doi: 10.1097/01.BRS.0000132513.88038.64
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Study Design. An unblinded comparison of laboratory values between patients with idiopathic and neuromuscular scoliosis.

Objectives. To compare standard tests of coagulation and thromboelastography (TEG) parameters between two groups of patients undergoing posterior spinal fusion (PSF).

Summary of Background Data. Children with neuromuscular scoliosis such as cerebral palsy have more intraoperative blood loss than children with idiopathic scoliosis during PSF. Various reasons suggested for this include nutritional deficiencies, altered tissue integrity, hepatic dysfunction, and use of antiepileptic medications that can cause poor hemostasis and altered coagulation. We have observed alterations in coagulation factor levels in patients with cerebral palsy due to spastic quadriplegia with moderate blood volume loss (25% estimated blood volume).

Methods. In a prospective analysis, we compared standard tests of coagulation (prothrombin time [PT], partial thromboplastin time [PTT], platelet count, fibrinogen levels) and TEG at baseline and at a blood loss of 15% estimated blood volume in patients with idiopathic scoliosis and cerebral palsy undergoing PSF.

Results. There were no differences between the groups in terms of gender distribution and age. There was a significant difference between the baseline PT and PTT values, although both groups were within laboratory norms. After 15% blood volume loss, there were differences seen in the PT, PTT, maximum amplitude on the TEG, ionized calcium, and serum magnesium levels (P < 0.05).

Conclusions. Children with cerebral palsy undergoing PSF have increased bleeding that starts earlier in the procedure than it does for patients with idiopathic scoliosis undergoing PSF. We found that, even though children with spastic quadriplegia had baseline PT and PTT values within normal limits, they were significantly different when compared with normal patients.

This paper provides a comparison of standard tests of coagulation and thromboelastography parameters between two groups of patients undergoing posterior spinal fusion. Patients with idiopathic scoliosis and neuromuscular scoliosis caused by cerebral palsy had blood drawn at baseline and after 15% blood volume loss. These data were compared to elucidate the differences in bleeding during major surgery between these two groups.

From the Departments of *Anesthesiology and Critical Care and †Orthopaedics, Nemours Children’s Clinic–Wilmington, Alfred I. duPont Hospital for Children, Wilmington, DE.

Acknowledgment date: June 16, 2003. First revision date: September 25, 2003. Acceptance date: November 17, 2003.

Supported by the Nemours Foundation.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to B. Randall Brenn, MD, Department of Anesthesiology and Critical Care, Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899; E-mail: brbrenn@nemours.org

© 2004 Lippincott Williams & Wilkins, Inc.