The effects of hemodilution on coagulation in term parturients: an <i>in vitro</i> study utilizing rotational thromboelastometry

Getrajdman, Chloe; Sison, Matthew; Lin, Hung‐Mo; Katz, Daniel

doi:10.1080/14767058.2020.1776250

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…During pregnancy, physiologic iron demands a substantial increase by one gram to support fetoplacental development, maternal adaptation to pregnancy, and parturition [ 6 ]. Red blood cells (RBC) during pregnancy tend to increase in number; however, blood plasma increases to a greater extent, generating blood hemodilution that also affects platelets as pregnancy progresses, causing a slight progressive decrease in the concentration of both cells [ 7 , 8 ]. Serum ferritin also decreases as an effect of hemodilution but also may reflect efficient iron mobilization from stores in agreement with the progressive hepcidin decrease during pregnancy [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status

Figueroa-Mujica

Ccahuantico

Ccorahua-Ríos

et al. 2022

Life

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The objectives of the study were to determine differences in the parameters of red blood cells (RBC), white blood cells (WBC), and platelets at low altitude (LA) and at high altitude (HA) and with the gestation being advanced, and to determine correlations between parameters of RBC and platelets. We also studied the association of RBC and platelets with markers of iron status. In addition, markers of iron status and inflammation were measured and compared at each trimester of gestation in pregnant women at LA and HA. A cross-sectional comparative study was conducted at Lima (150 m above sea level) and Cusco at 3400 m above sea level from May to December 2019. Hematological parameters in pregnant women (233 at LA and 211 at HA) were analyzed using an automated hematology analyzer. Serum ferritin levels, soluble transferrin receptor (sTfR), hepcidin, erythropoietin, testosterone, estradiol, and interleukin-6 (IL6) levels were measured by ELISA. One-way ANOVA supplemented with post hoc test, chi-square test, and Pearson correlation test statistical analyses were performed. p < 0.05 was considered significant. Pregnant woman at HA compared to LA had significantly lower WBC (p < 0.01), associated with higher parameters of the RBC, except for the mean corpuscular volume (MCV) that was no different (p > 0.05). Platelets and mean platelet volume (MPV) were higher (p < 0.01), and platelet distribution width (PDW) was lower at HA than at LA (p < 0.01). A higher value of serum ferritin (p < 0.01), testosterone (p < 0.05), and hepcidin (p < 0.01) was observed at HA, while the concentration of sTfR was lower at HA than at LA (p < 0.01). At LA, neutrophils increased in the third trimester (p < 0.05). RBC parameters decreased with the progress of the gestation, except RDW-CV, which increased. The platelet count decreased and the MPV and PDW were significantly higher in the third trimester. Serum ferritin, hepcidin, and serum testosterone decreased, while sTfR and serum estradiol increased during gestation. At HA, the WBC and red blood cell distribution width- coefficient of variation (RDW-CV), PCT, and serum IL-6 did not change with gestational trimesters. RBC, hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), and platelet count were lower as gestation advanced. MCV, MPV, and PDW increased in the third trimester. Serum ferritin, testosterone, and hepcidin were lower in the third trimester. Serum estradiol, erythropoietin, and sTfR increased as gestation progressed. Direct or inverse correlations were observed between RBC and platelet parameters and LA and HA. A better number of significant correlations were observed at HA. Hb, Hct, and RDW-CV showed a significant correlation with serum ferritin at LA and HA. Of these parameters, RDW-CV and PDW showed an inversely significant association with ferritin (p < 0.05). In conclusion, a different pattern was observed in hematological markers as well as in iron status markers between pregnant women at LA and HA. In pregnant women a significant correlation between several RBC parameters with platelet marker parameters was also observed. Data suggest that pregnant women at HA have adequate iron status during pregnancy as reflected by higher serum ferritin levels, lower sTfR levels, and higher hepcidin values than pregnant women at LA.

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Section: Introductionmentioning

confidence: 99%

A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status

Figueroa-Mujica

Ccahuantico

Ccorahua-Ríos

et al. 2022

Life

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“…This may be the result of the dilution of coagulation factors when hemodilution increases. 40 Although the mechanism behind this observation still needs to be further clarified as MPs are also diluted in this preparation. MPs-ACT also detected a hypocoagulable trend using sample volumes of 300 or 350 μL, which may be attributed to the relative deficiency of calcium chloride at this dilution.…”

Section: Discussionmentioning

confidence: 98%

MPs-ACT, an Assay to Evaluate the Procoagulant Activity of Microparticles

Gao

Qin

et al. 2023

Clin Appl Thromb Hemost

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The procoagulant effect of microparticles (MPs) contributes to hypercoagulability-induced thrombosis. We provide preliminary findings of the MPs-Activated Clotting Time (MPs-ACT) assay to determine the procoagulant activity of MPs. MPs-rich plasma was obtained and recalcified. Changes in plasma viscoelasticity were evaluated and the time to the peak viscoelastic changes was defined as the MPs-ACT. MPs concentration was measured by flow cytometry. Coagulation products produced during plasma clotting were identified by fibrin and fibrinopeptide A. MPs were prepared in vitro and added to standard plasma to simulate pathological samples. In addition, reproducibility and sensitivity were evaluated. We confirmed the linear relationship between MPs-ACT and MP concentrations. Dynamic changes in fibrin production were depicted. We simulated the correlation between MPs-ACT and standard plasma containing MPs prepared in vitro. The reproducibility of high-value and low-value samples was 6.0% and 10.8%, respectively. MPs-ACT sensitively detected hypercoagulable samples from patients with pre-eclampsia, hip fractures, and lung tumors. MPs-ACT largely reflects the procoagulant effect of MPs. MPs-ACT sensitively and rapidly detects hypercoagulability with MPs-rich plasma. It may be promising for the diagnosis of hypercoagulable states induced by MPs.

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“…However, in some patients this increase is less pronounced. These patients are at increased risk of major hemorrhage.14 When hemorrhage occurs fibrinogen also rapidly is diluted whilst the other coagulation factors are maintained at normal levels much longer 15 . Hence, avoiding or treating (hyper)fibrinolysis may be extremely valuable to boost clot formation and to stop obstetric hemorrhage.…”

Section: Coagulation During Deliverymentioning

confidence: 99%

“…Hence, microcirculatory thrombosis can be prevented. Observational evidence suggests that maternal fibrinolysis is activated at the time of delivery [15][16][17][18][19][20] . Indeed, evidence shows increased plasma urokinase-plasminogen activator or tissue plasminogen activator and decreased plasminogen activator inhibitor 1 levels after placental delivery.…”

Section: Coagulation During Deliverymentioning

confidence: 99%

The role of tranexamic acid in obstetric hemorrhage: a narrative review

Houwe¹,

Roofthooft²,

Velde³

2022

Acta Anaest Belg

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Abnormal postpartum hemorrhage is a common problem, complicating 3-5% of vaginal and operative deliveries. In a majority of cases (98%) uterine atony, retained placenta or genital tract lacerations are responsible for excessive blood loss. However, occasionally, serious coagulopathy may occur early after delivery or in specific circumstances such as with placental abruption. Also, when bleeding is caused by uterine atony, retained placenta or vaginal lacerations, a dilutional coagulopathy may develop. Hence correcting coagulation abnormalities is often required. Crucial to manage postpartum coagulopathy is the use of tranexamic acid to reduce hyperfibrinolysis. In the present narrative review, we will discuss the use of tranexamic acid for the prevention and management of major postpartum hemorrhage by reviewing the available literature.

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The effects of hemodilution on coagulation in term parturients: an in vitro study utilizing rotational thromboelastometry

Cited by 7 publications

References 11 publications

A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status

A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status

MPs-ACT, an Assay to Evaluate the Procoagulant Activity of Microparticles

The role of tranexamic acid in obstetric hemorrhage: a narrative review

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