Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock.
BACKGROUND
Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting. We aimed to determine the effect of RBCs on clotting parameters by comparing resuscitation regimens containing RBCs and plasma with those containing plasma alone.


METHODS
Thirty-two Yorkshire swine were anesthetized, subjected to a complex model of polytrauma and hemorrhagic shock, and resuscitated with either fresh frozen plasma, lyophilized plasma (LP), or 1:1 ratios of fresh frozen plasma:packed RBC (PRBC) or LP:PRBC. Activated clotting time, prothrombin time, partial thromboplastin time, and thrombelastography (TEG) were performed at 1 hour, 2 hours, 3 hours, and 4 hours after resuscitation.


RESULTS
Animals treated with 1:1 LP:PRBC had less blood loss than the other groups (p < 0.05). The activated clotting time was shorter in the 1:1 groups when compared with the pure plasma groups at all time points (p < 0.05). The 1:1 groups had shorter TEG R times (time to onset of clotting) at 1 hour, 3 hours, and 4 hours compared with pure plasma groups (p < 0.05). Other TEG parameters did not differ between groups. Partial thromboplastin time was shorter in the pure plasma groups than the 1:1 groups at all time points (p < 0.05).


CONCLUSIONS
Whole blood assays reveal that RBCs accelerate the onset of clot formation. Coagulation assays using spun plasma underestimate the effect of RBCs on clotting and do not completely characterize clot formation.
Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
Nicholas J
NJ
Spoerke
Philbert Y
PY
Van
Jerome A
JA
Differding
Karen A
KA
Zink
S David
SD
Cho
Patrick J
PJ
Muller
Z Ayhan
ZA
Karahan
Jill L
JL
Sondeen
John B
JB
Holcomb
Martin A
MA
Schreiber
D000818:Animals; D001777:Blood Coagulation / Q000502:physiology*; D004195:Disease Models, Animal; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000209:etiology; D004906:Erythrocyte Count; D004912:Erythrocytes / Q000502:physiology*; D006400:Hematocrit; D009104:Multiple Trauma / Q000097:blood* / Q000150:complications; D011517:Prothrombin Time; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000097:blood* / Q000150:complications / Q000628:therapy; D013552:Swine; D013916:Thrombelastography