Free oscillation rheometry monitoring of haemodilution and hypothermia and correction with fibrinogen and factor XIII concentrates

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Ulf Schött¹  Knut Olanders¹  Nahreen Tynngård²  Dag Winstedt¹ 

[1] Consultant Anaesthetist, Lund University, Skane Universisty Hospital, Lund, 221 85 Lund, Sweden;Department of Clinical Immunology and Transfusion Medicine, County Council of Östergötland, Linköping, Sweden

关键词: Ringer’s acetate solution;    Hydroxyethyl starch;    Coagulopathy;    Hypothermia;    Haemodilution;    Factor XIII;    Fibrinogen;    Coagulation factor concentrate;    Thrombelastography;    Free oscillation rheometry;   

Others  :  811599
DOI  :  10.1186/1757-7241-21-20

 received in 2012-11-06, accepted in 2013-03-12,  发布年份 2013

【 摘 要 】

Background

Haemodilution and hypothermia induce coagulopathy separately, but their combined effect on coagulation has not been widely studied. Fibrinogen concentrate can correct dilutional coagulopathy and has an additional effect when combined with factor XIII concentrate. However, their effect on dilutional coagulopathy concomitant with hypothermia has not been studied previously. Free oscillation rheometry – FOR (Reorox®) – is a novel viscoelastic haemostatic assay that has not been studied in this context before.

Methods

Blood from 10 healthy volunteers was diluted by 33% with hydroxyethyl starch or Ringer’s acetate solutions. Effects of fibrinogen added in vitro with and without factor XIII were studied at 33°C and 37°C. Coagulation velocity (coagulation time) and clot strength (elasticity) were assessed with FOR. Coagulation was initiated in vitro with thromboplastin alone, or thromboplastin plus a platelet inhibitor.

Results

Hydroxyethyl starch increased the coagulation time and decreased clot strength significantly more than Ringer’s acetate solution, both in the presence and absence of a platelet inhibitor. There was a significant interaction between haemodilution with hydroxyethyl starch and hypothermia, resulting in increased coagulation time. After addition of fibrinogen, coagulation time shortened and elasticity increased, with the exception of fibrinogen-dependent clot strength (i.e., elasticity in the presence of a platelet inhibitor) after hydroxyethyl starch haemodilution. Factor XIII had an additional effect with fibrinogen on fibrinogen-dependent clot strength in blood diluted with Ringer’s acetate solution. Hypothermia did not influence any of the coagulation factor effects.

Conclusions

Both haemodilution and mild hypothermia impaired coagulation. Coagulopathy was more pronounced after haemodilution with hydroxyethyl starch than with Ringer’s acetate. Addition of fibrinogen with factor XIII was unable to reverse hydroxyethyl starch induced clot instability, but improved coagulation in blood diluted with Ringer’s acetate solution. Fibrinogen improved coagulation irrespective of hypothermia.

【 授权许可】

   
2013 Winstedt et al.; licensee BioMed Central Ltd.

【 图 表 】

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