The hemostatic profiles of patients with Type O and non-O blood after acute normovolemic hemodilution with 6% hydroxyethyl starch (130/0.4).
BACKGROUND
Individuals with Type O blood have been reported to have a tendency toward reduced Factor VIII and von Willebrand Factor (vWF) levels. If this is true, patients with Type O blood might be vulnerable to coagulopathy during acute normovolemic hemodilution using hydroxyethyl starch (HES), both from hemodilution as well as HES-related coagulopathy.


METHODS
Thirty non-O and 15 type O ASA 1 or 2 patients scheduled for spinal surgery involving more than two spinal levels were enrolled for the study. After anesthesia induction, 30% of the estimated blood volume was removed, and the volume was simultaneously replaced with 6% HES (130/0.4). Coagulation profiles were measured before (T0) and 30 min after acute normovolemic hemodilution (T30).


RESULTS
Factor VIII activity, vWF antigen levels (vWF:ag), and vWF ristocetin cofactor activity (vWF:RCof) were lower in the O group than in the non-O group before and after acute normovolemic hemodilution, and decreased below the normal range in the O group after acute normovolemic hemodilution. The decrease was beyond that expected from hemodilution alone. Maximum amplitude and coagulation index of the thromboelastogram decreased below the normal range in the O group after acute normovolemic hemodilution. The decrease in vWF:ag was related to the degree of blood loss, and was greater in patients in the O group.


CONCLUSIONS
Patients with Type O blood may have increased coagulation compromise, and greater dilution of Factor VIII activity, vWF:ag, and vWF:RCof after acute normovolemic hemodilution with HES.
Kang
Jin Gu
JG
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ahn
Hyun Joo
HJ
Kim
Gaab Soo
GS
Hahm
Tae Soo
TS
Lee
Jeong Jin
JJ
Gwak
Mi Sook
MS
Choi
Soo Joo
SJ
D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D000941:Antigens / Q000032:analysis; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005169:Factor VIII / Q000032:analysis; D005260:Female; D006438:Hemodilution; D006487:Hemostasis; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D014841:von Willebrand Factor / Q000276:immunology
D000017:ABO Blood-Group System; D000941:Antigens; D006895:Hydroxyethyl Starch Derivatives; C029417:Von Willebrand antigen; D014841:von Willebrand Factor; D005169:Factor VIII