Accumulations of von Willebrand factor within ECMO oxygenators: Potential indicator of coagulation abnormalities in critically ill patients?

  • Clot formation within membrane oxygenators (MOs) remains a critical problem during extracorporeal membrane oxygenation (ECMO). The composition of the clots-in particular, the presence of von Willebrand factor (vWF)-may be an indicator for prevalent nonphysiological flow conditions, foreign body reactions, or coagulation abnormalities in critically ill patients. Mats of interwoven gas exchange fibers from randomly collected MOs (PLS, Maquet, Rastatt, Germany) of 21 patients were stained with antibodies (anti-vWF and anti-P-selectin) and counterstained with 4 ',6-diamidino-2-phenylindole. The extent of vWF-loading was correlated with patient and technical data. While 12 MOs showed low vWF-loadings, 9 MOs showed high vWF-loading with highest accumulations close to crossing points of adjacent gas fibers. The presence and the extent of vWF-fibers/"cobwebs," leukocytes, platelet-leukocyte aggregates (PLAs), and P-selectin-positive platelet aggregates were independent of the extent of vWF-loading. However, the highly loaded MOs were obtained from patients with a significantly elevated SOFA score, severe thrombocytopenia, and persistent liver dysfunction. The coagulation abnormalities of these critically ill patients may cause an accumulation of the highly thrombogenic and elongated high-molecular-weight vWF multimers in the plasma which will be trapped in the MOs during the ECMO therapy.

Export metadata

Additional Services

Share in Twitter Search Google Scholar Statistics
Metadaten
Author:Tamara Steiger, Maik FoltanORCiD, Alois Philipp, Thomas MuellerORCiD, Michael Andreas GruberORCiD, Andre BredthauerORCiD, Lars KrenkelORCiDGND, Clemens BirkenmaierORCiD, Karla LehleORCiD
DOI:https://doi.org/10.1111/aor.13513
ISSN:1525-1594
Parent Title (English):Artificial Organs
Publisher:Wiley
Place of publication:Hoboken
Document Type:Article
Language:English
Year of first Publication:2019
Release Date:2023/02/13
Tag:BLOOD FLOW; ECMO; INFLAMMATION; PLATELET ACTIVATION; THROMBOSIS
Volume:43
Issue:11
First Page:1065
Last Page:1076
Institutes:Fakultät Maschinenbau
Regensburg Center of Biomedical Engineering - RCBE
Fakultät Maschinenbau / Labor Biofluidmechanik
Begutachtungsstatus:peer-reviewed
research focus:Lebenswissenschaften und Ethik
OpenAccess Publikationsweg:Hybrid Open Access - OA-Veröffentlichung in einer Subskriptionszeitschrift/-medium
Licence (German):Creative Commons - CC BY-NC-ND - Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International