weekly_question 21/3/2021

[Admin]

A full term neonate is placed on ECMO for respiratory failure. She is stable and the flows are being weaned on day three when there is a reduction in urine output and the urine color becomes dark.

Which of the following blood tests would best identify the diagnosis?

A Hematocrit

B Lactate

C Methemoglobin

D Plasma free hemoglobin

E Ceruloplasmin

[Admin]

correct answer
D Plasma free hemoglobin


ECMO (ExtraCorporeal Membrane Oxygenation) or ECLS (ExtraCorporeal Life Support) is a life-saving support mechanism for neonates and infants with cardiorespiratory failure that is not responding to conventional therapy. This support requires the use of an external pump which draws blood from the right side of the heart and delivers oxygenated blood back to either the left or right side. As the blood traverses the extracorporeal circuit, it can undergo a number of perturbations including the development of thrombotic or hemolytic issues.

Hemolysis is one of the more frequent complications. At high levels it can result in serious neurologic and renal sequelae with high bilirubin levels and acute tubular necrosis. The type of pump used (centrifugal vs. roller head) has been studied recently as most centers have migrated to the exclusive use of centrifugal pumps. In smaller patients (neonates and infants), the lower flow rates have been noted to result in higher rates of hemolysis with these centrifugal pumps. In an analysis from the ELSO (ExtraCorporeal Life Support Organization) registry, two reports have noted this phenomenon and expressed concern regarding a potential higher incidence of renal dysfunction.

Detection of hemolysis is typically measured with plasma free hemoglobin levels. Many centers have adopted the routine use of this test while on ECMO. In addition to hemoglobin, reduced levels of haptoglobin would be diagnostic of increased hemolysis. Measuring hematocrit would not be an accurate indicator of hemolysis, and neither would lactate levels (perfusion), methemoglobin (drug interactions), or ceruloplasmin (copper).

[Sharon]

D

[Sadeq Taqoub]

D

[Admin]

correct answer
D Plasma free hemoglobin


ECMO (ExtraCorporeal Membrane Oxygenation) or ECLS (ExtraCorporeal Life Support) is a life-saving support mechanism for neonates and infants with cardiorespiratory failure that is not responding to conventional therapy. This support requires the use of an external pump which draws blood from the right side of the heart and delivers oxygenated blood back to either the left or right side. As the blood traverses the extracorporeal circuit, it can undergo a number of perturbations including the development of thrombotic or hemolytic issues.

Hemolysis is one of the more frequent complications. At high levels it can result in serious neurologic and renal sequelae with high bilirubin levels and acute tubular necrosis. The type of pump used (centrifugal vs. roller head) has been studied recently as most centers have migrated to the exclusive use of centrifugal pumps. In smaller patients (neonates and infants), the lower flow rates have been noted to result in higher rates of hemolysis with these centrifugal pumps. In an analysis from the ELSO (ExtraCorporeal Life Support Organization) registry, two reports have noted this phenomenon and expressed concern regarding a potential higher incidence of renal dysfunction.

Detection of hemolysis is typically measured with plasma free hemoglobin levels. Many centers have adopted the routine use of this test while on ECMO. In addition to hemoglobin, reduced levels of haptoglobin would be diagnostic of increased hemolysis. Measuring hematocrit would not be an accurate indicator of hemolysis, and neither would lactate levels (perfusion), methemoglobin (drug interactions), or ceruloplasmin (copper).

[iantsai]

D.
due to hemolysis was possible ECMO related complication