title: Hemodilution is not critical in the pathogenesis of the acute coagulopathy of trauma.
abstract: BACKGROUND
  The acute coagulopathy of trauma is multifactorial, but generally believed to be aggravated by coexisting acidosis, hypothermia, and hemodilution. While acidosis and hypothermia have been extensively evaluated, there is a paucity of data on the independent role of hemodilution in this scenario. We therefore hypothesized that hemodilution will impair coagulation following experimental trauma and hemorrhagic shock.
  
  
  METHODS
  Adult male Spraque-Dawley rats underwent trauma and hemorrhagic shock, followed by resuscitation with 2 × SBV using normal saline (NS). Thrombelastography (TEG) was performed before and after shock.
  
  
  RESULTS
  In this trauma model, resuscitation resulted in a hemodilution of 50% (43% ± 4.05% versus 19.8% ± 3.96% Hct pre-shock versus post-shock , P < 0.0001). Despite the substantial hemodilution, there was no significant change in clot strength (12.96 ± 2.84 versus 11.79 ± 1.28 dynes/cm(2) G pre-shock versus post-shock, P = 0.13). Similarly, the onset of coagulation (R time) was not impaired (1.68 ± 1.74 s versus 1.75 ± 0.63 s R time pre-shock versus post-shock, P = 0.45).
  
  
  CONCLUSIONS
  In the absence of hypothermia and acidosis, hemodilution (≤ 50%) has a trivial effect on coagulation following trauma and hemorrhagic shock. These data call to question the commonly held belief that hemodilution per se is critical in the development of post-injury coagulopathy.
authors.affiliation: Department of Surgery, University of Colorado Denver, Denver, Colorado, USA.
authors.forename: Max Valentin
authors.initials: MV
authors.lastname: Wohlauer
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Droz
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Harr
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gonzalez
authors.forename: Miguel
authors.initials: M
authors.lastname: Fragoso
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Silliman
mesh_terms: D000138:Acidosis / Q000150:complications; D000818:Animals; D001778:Blood Coagulation Disorders / Q000209:etiology*; D006438:Hemodilution / Q000009:adverse effects*; D007035:Hypothermia / Q000150:complications; D008297:Male; D023421:Models, Animal; D051381:Rats; D017207:Rats, Sprague-Dawley; D013916:Thrombelastography; D014947:Wounds and Injuries / Q000150:complications*