Hemodilution is not critical in the pathogenesis of the acute coagulopathy of trauma. J Surg Res 2012 Mar;173(1):26-30
Date
06/24/2011Pubmed ID
21696767Pubmed Central ID
PMC3179808DOI
10.1016/j.jss.2011.04.047Scopus ID
2-s2.0-84857054953 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
BACKGROUND: The acute coagulopathy of trauma is multifactorial, but generally believed to be aggravated by coexisting acidosis, hypothermia, and hemodilution. While acidosis and hypothermia have been extensively evaluated, there is a paucity of data on the independent role of hemodilution in this scenario. We therefore hypothesized that hemodilution will impair coagulation following experimental trauma and hemorrhagic shock.
METHODS: Adult male Spraque-Dawley rats underwent trauma and hemorrhagic shock, followed by resuscitation with 2 × SBV using normal saline (NS). Thrombelastography (TEG) was performed before and after shock.
RESULTS: In this trauma model, resuscitation resulted in a hemodilution of 50% (43% ± 4.05% versus 19.8% ± 3.96% Hct pre-shock versus post-shock , P < 0.0001). Despite the substantial hemodilution, there was no significant change in clot strength (12.96 ± 2.84 versus 11.79 ± 1.28 dynes/cm(2) G pre-shock versus post-shock, P = 0.13). Similarly, the onset of coagulation (R time) was not impaired (1.68 ± 1.74 s versus 1.75 ± 0.63 s R time pre-shock versus post-shock, P = 0.45).
CONCLUSION: In the absence of hypothermia and acidosis, hemodilution (≤ 50%) has a trivial effect on coagulation following trauma and hemorrhagic shock. These data call to question the commonly held belief that hemodilution per se is critical in the development of post-injury coagulopathy.
Author List
Wohlauer MV, Moore EE, Droz NM, Harr J, Gonzalez E, Fragoso M, Silliman CCMESH terms used to index this publication - Major topics in bold
AcidosisAnimals
Blood Coagulation Disorders
Hemodilution
Hypothermia
Male
Models, Animal
Rats
Rats, Sprague-Dawley
Thrombelastography
Wounds and Injuries
