Enhancement of coagulation caused by transfusion of artificial plasma-replacement solutions

Abstract

Aim. To investigate hemostasis disorders caused by massive blood transfusions of artificial plasma replacing solutions (PRS). Material and methods. Two groups of patients were examined: 7 healthy volunteers without blood loss (group 1) and 11 healthy donors of bone marrow with intraoperative blood loss 1-2 l (group 2). Five patients of group 1 received transfusion of 12 ml/kg hydroxyethyl starch (HES) 130/0.4, two patients of group 1 received transfusion of modified gelatine solution (gelofusin). All of them received infusions (1-1.5 l) of crystalloid PRS (1-2 l) and infusion of one of colloid PRS (6-HES, 5 - gelofusin). Estimated hemodilution in group 1 was 1.17 ± 0.01 times, in group 2 it varied from 1.3 to 2.7 times (mean 1.78 ± 0.4 times). Hemostasis was studied by clot growth rate (for groups 1 and 2), endogenic thrombin potential and parameters of thromboelastography (for group 2) in plasm samples obtained before, 2.24 and 48 hours after infusion of colloid PRS. Results. For both groups spatial clot growth rate 2 hours after hemodilution was high. Then it fell and reached baseline level 48 hours after PRS infusion. Endogenic thrombin potential and thromboelastography data (for group 2) changed by the same pattern. A hypercoagulation effect of gelofusin on parameters of thromboelastography and clot growth rate was higher than of HES 130/04. Conclusion. Moderate hemodilution with PRS in vivo causes hypercoagulation which persisted longer than volemic effect of PRS.

Keywords

• blood coagulation
• marrow donors
• hemodilution
• colloid plasma expanders
• spatial clot growth rate
• endogenous thrombin potential
• thrombelastography