Effects of Acute Normovolemic Hemodilution on Blood Coagulation: Comparison between Tests of an In Vivo and an In Vitro Model

Souza, Marco Aurélio Beloto de; Klamt, Jyrson Guilherme; Garcia, L

doi:10.1016/s0034-7094(10)70045-3

Cited by 5 publications

(7 citation statements)

References 35 publications

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“…While increased PT time is a nonspecific marker, the decreased fibrinogen levels and increased PT times observed in the study are consistent with dilutional coagulopathy as well . De Souza et al associated decreases in fibrinogen levels and platelet counts and increases in PT and PTT times in vivo and in vitro with hemodilution using lactated ringers solution . Fibrinogen depletion is also known to be the first factor to reach critically low levels during dilutional coagulopathy, and was found to be associated with transfusions in this cohort .…”

Section: Discussionmentioning

confidence: 53%

“…25 De Souza et al associated decreases in fibrinogen levels and platelet counts and increases in PT and PTT times in vivo and in vitro with hemodilution using lactated ringers solution. 28 Fibrinogen depletion is also known to be the first factor to reach critically low levels during dilutional coagulopathy, and was found to be associated with transfusions in this cohort. 37 Lastly, dilutional coagulopathy during major orthopedic surgery was previously shown to be principally a problem of fibrinogen polymerization.…”

Section: Discussionmentioning

confidence: 67%

“…25,26 In the trauma literature, trauma-induced coagulopathy has been associated with lower coagulation factor levels which may result from hemodilution and may be prevented by decreasing crystalloid administration. 27 Furthermore, several other in vitro studies show impaired hemostasis with hemodilution [28][29][30][31] Given the pediatric scoliosis population's well-recognized predilection to bleed despite antifibrinolytic medication, we hypothesized that dilutional coagulopathies occur during PSF and contribute to breakthrough bleeding. The primary outcomes of this study were Estimated Blood Volume (EBL) and the volume of red blood cell (RBC) product transfused during PSF for pediatric scoliosis.…”

Section: Introductionmentioning

confidence: 99%

“…In the trauma literature, trauma‐induced coagulopathy has been associated with lower coagulation factor levels which may result from hemodilution and may be prevented by decreasing crystalloid administration . Furthermore, several other in vitro studies show impaired hemostasis with hemodilution…”

Section: Introductionmentioning

confidence: 99%

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Dilutional coagulopathy in pediatric scoliosis surgery: A single center report

Baker

Marvi

Austin

et al. 2018

Pediatric Anesthesia

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Summary Background Children undergoing posterior spinal fusion experience high blood loss often necessitating transfusion. An appropriately activated coagulation system provides hemostasis during surgery, but pathologic dysregulation can cause progressive bleeding and increased transfusions. Despite receiving antifibrinolytics for clot stabilization, many patients still require transfusions. Aims We sought to examine the association of dilutional coagulopathy with blood loss and blood transfusion in posterior spinal fusion for pediatric scoliosis patients. Methods A retrospective, single institution study of children undergoing posterior spinal fusion >6 levels with a standardized, prospective anesthetic protocol utilizing antifibrinolytics. Blood loss was evaluated using a hematocrit‐based calculation. To evaluate transfusions, a normalized Blood Product Transfusion calculation was developed. Factors associated with blood loss and blood transfusions were determined by univariate analysis and multivariate regression modeling with multicollinearity and mediation analysis. Results Patients received 73.7 mL/kg (standard deviation ±30.8) of fluid poor in coagulation factors. Estimated blood loss was 42.6 mL/kg (standard deviation ±18.0). There was a significant association between estimated blood loss and total fluids delivered (Spearman's rho = 0.51, 95% confidence interval 0.33‐0.65, P < 0.001). Factors significantly associated with normalized Blood Product Transfusion in this cohort included age, weight, scoliosis type, levels fused, total osteotomies, pelvic fixation, total fluid, maximum prothrombin time, and minimum fibrinogen. Regression modeling showed the best combination of variables for modeling normalized Blood Product Transfusion included patient weight, number of levels fused, total fluid administered, and maximum prothrombin time. Conclusion Blood product transfusion remains a frustrating problem in pediatric scoliosis. Identifying and controlling dilutional coagulopathy in these patients may reduce blood loss and the need for blood transfusion.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dilutional coagulopathy in pediatric scoliosis surgery: A single center report

Baker

Marvi

Austin

et al. 2018

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“… reported that 50% haemodilution with crystalloid caused a hypocoagulable state. Although viscoelastometric analysis was not used to assess the coagulation state, the coagulation parameters were prolonged in vitro after ANH with crystalloid, indicating a hypocoagulable state . In our study, each patient lost 960 ml autologous blood .…”

mentioning

confidence: 77%