The influence of cardiopulmonary bypass on the size of human platelets

Large and small platelets are present in the bloodstream in nearly equal proportions and comprise about 30% of the normal platelet population. The assumption that cardiopulmonary bypass may alter this platelet population distribution was investigated. Platelet volume distribution curves during and after cardiopulmonary bypass were examined in 12 patients undergoing various intracardiac operation by an electronic particle sizing apparatus based on the Coulter counter. Mean platelet volume (MPV) was 8.6±0.7 cubic microns prior to cardiopulmonary bypass. Ten minutes after commencement of cardiopulmonary bypass the MPV decreased to 85% of control levels. A further decrease, reaching a plateau at 75% of prebypass MPV, was reached after 50 minutes on bypass. MPV returned to 87% of prebypass levels 2 hours after discontinuation of cardiopulmonary bypass. Since it is known that platelet count is markedly reduced on cardiopulmonary bypass, a simultaneous 25% decrease in MPV can be explained only by a highly selective disappearance of the large platelets from the circulation. As the larger platelets are younger and functionally more potent than the smaller ones, the selective disappearance of large platelets may thus provide an explanation for the observed alteration in platelet adhesiveness caused by cardiopulmonary bypass.