title: The effect of fibrinogen concentrate and factor XIII on thromboelastometry in 33% diluted blood with albumin, gelatine, hydroxyethyl starch or saline in vitro.
abstract: BACKGROUND
  Fluid replacement results in dilutional coagulopathy. We investigated the potential role of fibrinogen, factor XIII and a combination of both to reverse dilutional coagulopathy, assessed by thromboelastometry (ROTEM(®)).
  
  
  METHODS
  Blood samples from healthy volunteers were analysed undiluted and after 33% dilution in vitro with albumin, gelatine, 130/0.4 hydroxyethyl starch or saline. Diluted samples were incubated with fibrinogen (3 g/70 kg bodyweight equivalent), factor XIII (10,000 IU/70 kg bodyweight equivalent), or a combination of both. Measurements were performed using an extrinsic activated assay (EXTEM(®)) and a functional fibrin polymerisation test (FIBTEM(®)).
  
  
  RESULTS
  Compared with baseline, EXTEM clotting time increased with hydroxyethyl starch, exceeding the upper limit of the reference value. Albumin prolonged clotting time within normal limits. Gelatine did not change clotting time, and saline reduced clotting time. Clot formation time increased in colloids only. Maximum clot firmness of both EXTEM and FIBTEM decreased with all fluids, but was less pronounced in saline. Incubation with fibrinogen had no effect on EXTEM maximum clot firmness but improved FIBTEM maximum clot firmness in saline (P <0.001) and albumin (P <0.05), but not gelatine and hydroxyethyl starch). Factor XIII had no effect on any EXTEM and FIBTEM maximum clot firmness results. Fibrinogen and factor XIII combined did not improve EXTEM maximum clot firmness. Fibrinogen and factor XIII did not change FIBTEM maximum clot firmness in hydroxyethyl starch but improved FIBTEM maximum clot firmness in albumin (P <0.001), gelatine (P <0.01) and saline (P <0.001).
  
  
  CONCLUSIONS
  ROTEM parameters in dilutional coagulopathy in vitro cannot be improved with factor XIII alone in any tested diluent. The combination of fibrinogen and factor XIII is highly effective in raising FIBTEM maximum clot firmness after dilution with albumin, gelatine and saline back to normal values, but is ineffective in 130/0.4 hydroxyethyl starch.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Workers' Compensation Board (AUVA) Research Centre, Vienna, Austria.
authors.forename: Christoph Johannes
authors.initials: CJ
authors.lastname: Schlimp
authors.affiliation: Department of Laboratory Medicine, University Hospital of Salzburg, Salzburg, Austria.
authors.forename: Janne
authors.initials: J
authors.lastname: Cadamuro
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Workers' Compensation Board (AUVA) Research Centre, Vienna, Austria.
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Workers' Compensation Board (AUVA) Research Centre, Vienna, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Redl
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Workers' Compensation Board (AUVA) Research Centre, Vienna, Austria Department of Anaesthesiology and Intensive Care, Austrian Workers' Compensation Board (AUVA) Trauma Hospital Salzburg, Salzburg, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
mesh_terms: D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000097:blood; D005176:Factor XIII / Q000494:pharmacology*; D005340:Fibrinogen / Q000494:pharmacology*; D005780:Gelatin / Q000494:pharmacology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000494:pharmacology*; D012709:Serum Albumin / Q000494:pharmacology*; D012965:Sodium Chloride / Q000494:pharmacology*; D013916:Thrombelastography / Q000379:methods*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012709:Serum Albumin; D012965:Sodium Chloride; D005780:Gelatin; D005340:Fibrinogen; D005176:Factor XIII