The plasma dilution factor: predicting how concentrations in plasma and serum are affected by blood volume variations and blood loss.
To determine the effects of therapeutic interventions on plasma protein concentrations, it is often desirable to rule out nonspecific effects of hemodilution. Because red cells are restricted to the vascular space, the hematocrit (Hct) is a convenient marker. At the bedside--and even in scientific reports--a simple ratio of Hcts (obtained before and after the change in plasma volume) is often used to "correct" the value of interest. This is incorrect, and it may introduce a sizeable error. A new method, the plasma dilution factor (PDF), has been mathematically deduced. It accounts for the influence of any blood loss, plasma osmolality changes, and blood volume variations on plasma and serum concentrations. In an in vitro experiment, blood loss and osmolality and blood volume changes were simulated through the withdrawal of various volumes of blood, which were replaced with smaller, identical, or larger volumes of hypotonic, isotonic, or hypertonic solutions. The PDF accurately predicted changes in concentrations of albumin, fibrinogen, and antithrombin III. In contrast, the Hct ratio significantly underestimated the effects of dilution. Von Willebrand factor concentrations after hemodilution through dextran infusion in volunteers were the same as predicted by the PDF. In patients undergoing orthopedic surgery who were also given dextran, the postdilution von Willebrand factor concentrations were higher than predicted by the PDF. The Hct gave a false impression of a decrease in the volunteers that was not explained by hemodilution, and it failed to detect the von Willebrand factor response to trauma in the surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Flordal
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Karolinska Institute, Department of Surgery at Danderyd Hospital, Sweden.
D000990:Antithrombin III / Q000032:analysis; D015415:Biomarkers / Q000097:blood; D001802:Blood Substitutes; D001810:Blood Volume; D003911:Dextrans; D006400:Hematocrit; D006438:Hemodilution; D006470:Hemorrhage / Q000097:blood* / Q000628:therapy; D006801:Humans; D008433:Mathematics; D008962:Models, Theoretical; D010952:Plasma Substitutes; D011237:Predictive Value of Tests; D012016:Reference Values; D015203:Reproducibility of Results; D012709:Serum Albumin / Q000032:analysis; D014841:von Willebrand Factor / Q000032:analysis*
D015415:Biomarkers; D001802:Blood Substitutes; D003911:Dextrans; D010952:Plasma Substitutes; D012709:Serum Albumin; D014841:von Willebrand Factor; D000990:Antithrombin III