Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock

Nicholas J. Spoerke, Philbert Van, Jerome A. Differding, Karen A. Zink, S. David Cho, Patrick J. Muller, Z. Ayhan Karahan, Jill L. Sondeen, John B. Holcomb, Martin Schreiber

    Research output: Contribution to journalArticle

    16 Citations (Scopus)

    Abstract

    Background: Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting. We aimed to determine the effect of RBCs on clotting parameters by comparing resuscitation regimens containing RBCs and plasma with those containing plasma alone. Methods: Thirty-two Yorkshire swine were anesthetized, subjected to a complex model of polytrauma and hemorrhagic shock, and resuscitated with either fresh frozen plasma, lyophilized plasma (LP), or 1:1 ratios of fresh frozen plasma:packed RBC (PRBC) or LP:PRBC. Activated clotting time, prothrombin time, partial thromboplastin time, and thrombelastography (TEG) were performed at 1 hour, 2 hours, 3 hours, and 4 hours after resuscitation. Results: Animals treated with 1:1 LP:PRBC had less blood loss than the other groups (p <0.05). The activated clotting time was shorter in the 1:1 groups when compared with the pure plasma groups at all time points (p <0.05). The 1:1 groups had shorter TEG R times (time to onset of clotting) at 1 hour, 3 hours, and 4 hours compared with pure plasma groups (p <0.05). Other TEG parameters did not differ between groups. Partial thromboplastin time was shorter in the pure plasma groups than the 1:1 groups at all time points (p <0.05). Conclusions: Whole blood assays reveal that RBCs accelerate the onset of clot formation. Coagulation assays using spun plasma underestimate the effect of RBCs on clotting and do not completely characterize clot formation.

    Original languageEnglish (US)
    Pages (from-to)1054-1059
    Number of pages6
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume69
    Issue number5
    DOIs
    StatePublished - Nov 2010

    Fingerprint

    Hemorrhagic Shock
    Multiple Trauma
    Erythrocytes
    Thrombelastography
    Partial Thromboplastin Time
    Resuscitation
    Prothrombin Time
    Swine
    Hemorrhage

    Keywords

    • Accelerated clot formation
    • Coagulopathy
    • Lyophilized plasma
    • Polytrauma

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

    Cite this

    Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock. / Spoerke, Nicholas J.; Van, Philbert; Differding, Jerome A.; Zink, Karen A.; Cho, S. David; Muller, Patrick J.; Karahan, Z. Ayhan; Sondeen, Jill L.; Holcomb, John B.; Schreiber, Martin.

    In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 69, No. 5, 11.2010, p. 1054-1059.

    Research output: Contribution to journalArticle

    Spoerke, NJ, Van, P, Differding, JA, Zink, KA, Cho, SD, Muller, PJ, Karahan, ZA, Sondeen, JL, Holcomb, JB & Schreiber, M 2010, 'Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock', Journal of Trauma - Injury, Infection and Critical Care, vol. 69, no. 5, pp. 1054-1059. https://doi.org/10.1097/TA.0b013e3181f9912a
    Spoerke, Nicholas J. ; Van, Philbert ; Differding, Jerome A. ; Zink, Karen A. ; Cho, S. David ; Muller, Patrick J. ; Karahan, Z. Ayhan ; Sondeen, Jill L. ; Holcomb, John B. ; Schreiber, Martin. / Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 69, No. 5. pp. 1054-1059.
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    abstract = "Background: Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting. We aimed to determine the effect of RBCs on clotting parameters by comparing resuscitation regimens containing RBCs and plasma with those containing plasma alone. Methods: Thirty-two Yorkshire swine were anesthetized, subjected to a complex model of polytrauma and hemorrhagic shock, and resuscitated with either fresh frozen plasma, lyophilized plasma (LP), or 1:1 ratios of fresh frozen plasma:packed RBC (PRBC) or LP:PRBC. Activated clotting time, prothrombin time, partial thromboplastin time, and thrombelastography (TEG) were performed at 1 hour, 2 hours, 3 hours, and 4 hours after resuscitation. Results: Animals treated with 1:1 LP:PRBC had less blood loss than the other groups (p <0.05). The activated clotting time was shorter in the 1:1 groups when compared with the pure plasma groups at all time points (p <0.05). The 1:1 groups had shorter TEG R times (time to onset of clotting) at 1 hour, 3 hours, and 4 hours compared with pure plasma groups (p <0.05). Other TEG parameters did not differ between groups. Partial thromboplastin time was shorter in the pure plasma groups than the 1:1 groups at all time points (p <0.05). Conclusions: Whole blood assays reveal that RBCs accelerate the onset of clot formation. Coagulation assays using spun plasma underestimate the effect of RBCs on clotting and do not completely characterize clot formation.",
    keywords = "Accelerated clot formation, Coagulopathy, Lyophilized plasma, Polytrauma",
    author = "Spoerke, {Nicholas J.} and Philbert Van and Differding, {Jerome A.} and Zink, {Karen A.} and Cho, {S. David} and Muller, {Patrick J.} and Karahan, {Z. Ayhan} and Sondeen, {Jill L.} and Holcomb, {John B.} and Martin Schreiber",
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    T1 - Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock

    AU - Spoerke, Nicholas J.

    AU - Van, Philbert

    AU - Differding, Jerome A.

    AU - Zink, Karen A.

    AU - Cho, S. David

    AU - Muller, Patrick J.

    AU - Karahan, Z. Ayhan

    AU - Sondeen, Jill L.

    AU - Holcomb, John B.

    AU - Schreiber, Martin

    PY - 2010/11

    Y1 - 2010/11

    N2 - Background: Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting. We aimed to determine the effect of RBCs on clotting parameters by comparing resuscitation regimens containing RBCs and plasma with those containing plasma alone. Methods: Thirty-two Yorkshire swine were anesthetized, subjected to a complex model of polytrauma and hemorrhagic shock, and resuscitated with either fresh frozen plasma, lyophilized plasma (LP), or 1:1 ratios of fresh frozen plasma:packed RBC (PRBC) or LP:PRBC. Activated clotting time, prothrombin time, partial thromboplastin time, and thrombelastography (TEG) were performed at 1 hour, 2 hours, 3 hours, and 4 hours after resuscitation. Results: Animals treated with 1:1 LP:PRBC had less blood loss than the other groups (p <0.05). The activated clotting time was shorter in the 1:1 groups when compared with the pure plasma groups at all time points (p <0.05). The 1:1 groups had shorter TEG R times (time to onset of clotting) at 1 hour, 3 hours, and 4 hours compared with pure plasma groups (p <0.05). Other TEG parameters did not differ between groups. Partial thromboplastin time was shorter in the pure plasma groups than the 1:1 groups at all time points (p <0.05). Conclusions: Whole blood assays reveal that RBCs accelerate the onset of clot formation. Coagulation assays using spun plasma underestimate the effect of RBCs on clotting and do not completely characterize clot formation.

    AB - Background: Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting. We aimed to determine the effect of RBCs on clotting parameters by comparing resuscitation regimens containing RBCs and plasma with those containing plasma alone. Methods: Thirty-two Yorkshire swine were anesthetized, subjected to a complex model of polytrauma and hemorrhagic shock, and resuscitated with either fresh frozen plasma, lyophilized plasma (LP), or 1:1 ratios of fresh frozen plasma:packed RBC (PRBC) or LP:PRBC. Activated clotting time, prothrombin time, partial thromboplastin time, and thrombelastography (TEG) were performed at 1 hour, 2 hours, 3 hours, and 4 hours after resuscitation. Results: Animals treated with 1:1 LP:PRBC had less blood loss than the other groups (p <0.05). The activated clotting time was shorter in the 1:1 groups when compared with the pure plasma groups at all time points (p <0.05). The 1:1 groups had shorter TEG R times (time to onset of clotting) at 1 hour, 3 hours, and 4 hours compared with pure plasma groups (p <0.05). Other TEG parameters did not differ between groups. Partial thromboplastin time was shorter in the pure plasma groups than the 1:1 groups at all time points (p <0.05). Conclusions: Whole blood assays reveal that RBCs accelerate the onset of clot formation. Coagulation assays using spun plasma underestimate the effect of RBCs on clotting and do not completely characterize clot formation.

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    KW - Coagulopathy

    KW - Lyophilized plasma

    KW - Polytrauma

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