TYK36
You have a 6 month old who just underwent repair of a complex congenital heart disease. On report, the team tells you they gave 300U/kg of heparin for CPB and upon separation from bypass gave 1.0mg of protamine per 100U of heparin given. They also administered 100 ml of cell saver blood from the perfusionist. Being concerned for postoperative bleeding, you then:
A. Give additional protamine because the cell saver blood from the pump will contain additional heparin
B. Give additional heparin because the cell saver blood will have excess protamine
C. Do nothing, no additional protamine needed
D. Go on break
Answer
The answer is C (most likely). Remember, that even though cell saver blood DOES come from the CPB circuit (which does contain heparin) it undergoes "washing" which removes over 99% of the heparin. Unlikely that additional protamine will be needed. Too much protamine may actually cause a coagulopathy.
Notes