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

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

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    17 Scopus citations

    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 1 2010

    Keywords

    • Accelerated clot formation
    • Coagulopathy
    • Lyophilized plasma
    • Polytrauma

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

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  • Cite this

    Spoerke, N. J., Van, P. Y., Differding, J. A., Zink, K. A., Cho, S. D., Muller, P. J., Karahan, Z. A., Sondeen, J. L., Holcomb, J. B., & Schreiber, M. A. (2010). Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock. Journal of Trauma - Injury, Infection and Critical Care, 69(5), 1054-1059. https://doi.org/10.1097/TA.0b013e3181f9912a