Functional capacity of reconstituted blood in 1:1:1 versus 3:1:1 ratios

TY - JOUR

T1 - Functional capacity of reconstituted blood in 1:1:1 versus 3:1:1 ratios

T2 - a thrombelastometry study

AU - Driessen, Arne

AU - Schäfer, Nadine

AU - Bauerfeind, Ursula

AU - Kaske, Sigune

AU - Fromm-Dornieden, Carolin

AU - Stuermer, Ewa K

AU - Maegele, Marc

PY - 2015/1/9

Y1 - 2015/1/9

N2 - INTRODUCTION: Different transfusion ratio concepts of packed red blood cells (pRBCs), fresh frozen plasma (FFP) and platelets (PLTs) have been implemented in trauma care, but the optimal ratios are still discussed. In this study the hemostatic potential of two predefined ratios was assessed by using an in vitro thrombelastometric approach. Furthermore, age effects of reconstituted blood were analyzed.METHODS: Whole blood (WB) of voluntary donors was separated into pRBCs, FFP and PLTs and reconstituted into the ratios 1:1:1 and 3:1:1 at day 1, 4, 14, and 24. Standard blood count, electrolytes and coagulation proteins were quantified. The functional coagulation in ratio- and age-specific groups was evaluated using rotational thromboelastometry (ROTEM).RESULTS: Several coagulation factors reduced significantly in the 3:1:1 ratio and were consistent with increased INR, decelerated clot formation times and A10 (amplitude 10 minutes after clotting time (CT)), flattened α-angle during the EXTEM and diminished MCF for distinct time points during the INTEM, FIBTEM and APTEM assays. With rising age of pRBCs the pH, sodium and potassium reached non-physiological levels.CONCLUSION: Under standardized in vitro conditions the higher amount of pRBCs in the 3:1:1 ratio diluted coagulation factors significantly on the expense of its functional coagulation capacity as revealed by ROTEM results. Thus, the coagulation functionality of the 1:1:1 ratio predominated.

AB - INTRODUCTION: Different transfusion ratio concepts of packed red blood cells (pRBCs), fresh frozen plasma (FFP) and platelets (PLTs) have been implemented in trauma care, but the optimal ratios are still discussed. In this study the hemostatic potential of two predefined ratios was assessed by using an in vitro thrombelastometric approach. Furthermore, age effects of reconstituted blood were analyzed.METHODS: Whole blood (WB) of voluntary donors was separated into pRBCs, FFP and PLTs and reconstituted into the ratios 1:1:1 and 3:1:1 at day 1, 4, 14, and 24. Standard blood count, electrolytes and coagulation proteins were quantified. The functional coagulation in ratio- and age-specific groups was evaluated using rotational thromboelastometry (ROTEM).RESULTS: Several coagulation factors reduced significantly in the 3:1:1 ratio and were consistent with increased INR, decelerated clot formation times and A10 (amplitude 10 minutes after clotting time (CT)), flattened α-angle during the EXTEM and diminished MCF for distinct time points during the INTEM, FIBTEM and APTEM assays. With rising age of pRBCs the pH, sodium and potassium reached non-physiological levels.CONCLUSION: Under standardized in vitro conditions the higher amount of pRBCs in the 3:1:1 ratio diluted coagulation factors significantly on the expense of its functional coagulation capacity as revealed by ROTEM results. Thus, the coagulation functionality of the 1:1:1 ratio predominated.

KW - Blood Coagulation Tests

KW - Blood Platelets/physiology

KW - Blood Transfusion/methods

KW - Erythrocytes/physiology

KW - Humans

KW - In Vitro Techniques

KW - International Normalized Ratio

KW - Plasma/physiology

KW - Thrombelastography

U2 - 10.1186/s13049-014-0080-0

DO - 10.1186/s13049-014-0080-0

M3 - SCORING: Journal article

C2 - 25571924

VL - 23

SP - 2

JO - SCAND J TRAUMA RESUS

JF - SCAND J TRAUMA RESUS

SN - 1757-7241

ER -