title: Does hemodilution enhance coagulability?
abstract: Recent publications reported enhanced coagulability in hemodilution determined by TEG. In contrast, earlier reports have shown prolongation of in-vivo bleeding time in anemia. In order to take a closer look at this discrepancy undiluted and diluted anticoagulated blood samples (20 % with saline solution, hydroxyl-ethyl starch 6 % (HES), autologous platelet poor plasma (PPP)) were investigated by TEG (n = 10), ball (n = 10), and hook coagulometer (n = 15) as well as tests simulating primary hemostasis ex vivo (Platelet Function Analyzer PFA-100, n = 10).
  
  
  RESULTS
  Dilution with plasma changed TEG parameters in a way, when started by recalcification of the blood sample, which is characteristic of enhanced coagulability (r decreased in all and k in 8 of 10 samples, maximal amplitude increased in 9 out of 10). With HES, changes in TEG parameters mainly indicated reduced coagulability (k increased in 7 out of 10, MA decreased in 10 out of 10). When the coagulation was additionally activated by PTT reagent (InTEG) the TEG parameters also mainly showed hypocoagulation with the three dilution solutions. Coagulation times with ball and hook coagulometers were significantly prolonged by dilution especially with saline (+ 25 % and + 17 %, p < 0.001). Dilution always significantly (often abnormally) prolonged closure time in PFA-100 (saline + 41 +/- 18 %, PPP + 37 +/- 20 %, HES + 69 +/- 24 %) demonstrating disturbance of primary hemostasis, particularly with HES.
  
  
  CONCLUSIONS
  From the results obtained it can be concluded that the changes in the classical TEG (without addition of PTT-reagent), suggesting an enhanced coagulability, may be caused methodically as they are also found with autologous PPP. On the other hand, a disturbance of the primary hemostasis in hemodilution has to be taken into account from the results seen with the PFA-100 and a number of published data.
authors.affiliation: Institute for Transfusion Medicine and Hemostaseology, University Hospital, Marburg, Germany. kretschv@mailer.uni-marburg.de
authors.forename: V
authors.initials: V
authors.lastname: Kretschmer
authors.forename: A
authors.initials: A
authors.lastname: Daraktchiev
authors.forename: S
authors.initials: S
authors.lastname: Bade
authors.forename: R
authors.initials: R
authors.lastname: Karger
authors.forename: M A
authors.initials: MA
authors.lastname: Kratzer
mesh_terms: D001777:Blood Coagulation; D006438:Hemodilution; D006801:Humans; D010979:Platelet Function Tests / Q000295:instrumentation; D013916:Thrombelastography