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Newborns on ECMO

This was posted by a colleague on another forum.  We have noticed that newborn babies plasma, after three weeks on extracorporeal membrane oxygenation (ECMO) becomes dark brown. On our instrument, the fibrinogen rises to approximately 800 mg/dL, though a reference lab reports it as critically low. We also notice falsely elevated platelet counts, for instance, 150,000 by impedance and 50,000 by optical, but the manual estimate is 15,000. The manufacturer says the fibrinogen could cause a falsely elevated platelet count. Could there be a common denominator causing these interferences?

Hello, and thank you for permission to post your findings. I suspect the variable fibrinogen and platelet counts reflect hemolysis. Hemolysis could interfere in different ways with clot-based and optical fibrinogen methods, and the combination of activated platelets and schistocytes could be affecting the platelet count. Neither the platelet count nor the fibrinogen results are reliable under these circumstances.

Have any of our participants had similar experiences with ECMO?

Comments (1)
Specimen Management
Dave McGlasson
Sep 9, 2014 4:42am

I think if the clotting assay were performed on a mechanical
I think if the clotting assay were performed on a mechanical clot-detection systems the problem with the fibrinogen would go away. Microfragments of RBC‘s can affect the platelet count on some hematology analyzers.

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