Platelets and cardiopulmonary bypass

Exposure of blood to an extracorporeal circulation, such as CPB, causes a variety of physiological responses. Haematological derangements are just one of many potential dangers to the patient who undergoes CPB. The paradox of CPB-related problems with the haematological system is that there are some factors tipping the balance towards a bleeding tendency, and others that favour a prothrombotic state. Both of these issues must be dealt with independently to create the safest environment for surgery. It has been demonstrated that platelets play a key role in both haemostatic dysfunction and thrombotic complications of CPB. Much has been achieved, both clinically and in the laboratory, in the understanding of the precise role platelets play in these events, but the exact mechanisms involved have yet to be completely identified. As research progresses, our understanding will increase, but until then clinical practice must be dictated by the current evidence available.