Physiofogical Hemodilution

Carey, Joseph S.; Williamson, Herbert; Moore, Clarence D.; LUNDBERC, HERBERT; Turner, Leon; Scott, C.; Sacks, Elliot

doi:10.1097/00000658-197307000-00018

Cited by 9 publications

(2 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ATC is characterized by exaggerated activation of thrombin and eventual depletion over time of multiple coagulation factors, platelets and inhibitors through transition to Coagulopathy of Trauma [3] . It occurs in the setting of shock where loss of hydrostatic pressure alters the net Starling fluid flux which drives progressive autodilution of blood [62] – [64] . Detection of increased aPC may reflect the final stages of a robust physiologic response to a massive hemostatic challenge rather than a primary anticoagulant response.…”

Section: Discussionmentioning

confidence: 99%

Comparative Response of Platelet fV and Plasma fV to Activated Protein C and Relevance to a Model of Acute Traumatic Coagulopathy

2014

View full text Add to dashboard Cite

BackgroundAcute traumatic coagulopathy (ATC) has been linked to an increase in activated protein C (aPC) from 40 pM in healthy individuals to 175 pM. aPC exerts its activity primarily through cleavage of active coagulation factor Va (fVa). Platelets reportedly possess fVa which is more resistant to aPC cleavage than plasma fVa; this work examines the hypothesis that normal platelets are sufficient to maintain coagulation in the presence of elevated aPC.MethodsCoagulation responses of normal plasma, fV deficient plasma (fVdp), and isolated normal platelets in fVdp were conducted: prothrombin (PT) tests, turbidimetry, and thromboelastography (TEG), including the dose response of aPC on the samples.ResultsPT and turbidimetric assays demonstrate that normal plasma is resistant to aPC at doses much higher than those found in ATC. Additionally, an average physiological number of washed normal platelets (200,000 platelets/mm3) was sufficient to eliminate the anti-coagulant effects of aPC up to 10 nM, nearly two orders of magnitude above the ATC concentration and even the steady-state pharmacological concentration of human recombinant aPC, as measured by TEG. aPC also demonstrated no significant effect on clot lysis in normal plasma samples with or without platelets.ConclusionsAlthough platelet fVa shows slightly superior resistance to aPC's effects compared to plasma fVa in static models, neither fVa is sufficiently cleaved in simulations of ATC or pharmacologically-delivered aPC to diminish coagulation parameters. aPC is likely a correlative indicator of ATC or may play a cooperative role with other activity altering products generated in ATC.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparative Response of Platelet fV and Plasma fV to Activated Protein C and Relevance to a Model of Acute Traumatic Coagulopathy

2014

View full text Add to dashboard Cite

show abstract

“…(16, 17) The activity of this system is also modulated by pH, temperature and the hemodilution that occurs from crystalloid resuscitation and reversal of Starling forces with shifts of fluid from the interstitium to the vascular compartment during hemorrhage. (18–20) A thrombus is the final result of the hemostatic process of clot formation. Conversely, thrombosis, is the result of a pathophysiologic process of inappropriate intravascular clotting, which causes tissue injury.…”

Section: Hemostasis and Coagulopathymentioning

confidence: 99%