{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:06:29Z","timestamp":1792098389367,"version":"4.4.0"},"reference-count":57,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2015,7,17]],"date-time":"2015-07-17T00:00:00Z","timestamp":1437091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Children with cyanotic congenital heart disease (\n                    <jats:styled-content style=\"fixed-case\">CCHD<\/jats:styled-content>\n                    ) have complex alterations in their whole blood composition and coagulation profile due to long\u2010standing hypoxemia. Secondary erythrocytosis is an associated physiological response intended to increase circulating red blood cells and oxygen carrying capacity. However, this response is frequently offset by an increase in whole blood viscosity that paradoxically reduces blood flow and tissue perfusion. In addition, the accompanying reduction in plasma volume leads to significant deficiencies in multiple coagulation proteins including platelets, fibrinogen and other clotting factors. On the one hand, these patients may suffer from severe hyperviscosity and subclinical \u2018sludging\u2019 in the peripheral vasculature with an increased risk of thrombosis. On the other hand, they are at an increased risk for postoperative hemorrhage due to a complex derangement in their hemostatic profile. Anesthesiologists caring for children with\n                    <jats:styled-content style=\"fixed-case\">CCHD<\/jats:styled-content>\n                    and secondary erythrocytosis need to understand the pathophysiology of these alterations and be aware of available strategies that lessen the risk of bleeding and\/or thrombosis. The aim of this review is to provide an updated analysis of the systemic effects of long\u2010standing hypoxemia in children with primary congenital heart disease with a specific focus on secondary erythrocytosis and hemostasis.\n                  <\/jats:p>","DOI":"10.1111\/pan.12705","type":"journal-article","created":{"date-parts":[[2015,7,17]],"date-time":"2015-07-17T02:41:51Z","timestamp":1437100911000},"page":"981-989","source":"Crossref","is-referenced-by-count":82,"title":["Cyanotic congenital heart disease (CCHD): focus on hypoxemia, secondary erythrocytosis, and coagulation alterations"],"prefix":"10.1111","volume":"25","author":[{"given":"Luis M.","family":"Zabala","sequence":"first","affiliation":[{"name":"Department of Anesthesiology University of Texas Southwestern Medical Center \u2010 Children's Health Dallas Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina 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