The effects of in vitro hemodilution and fibrinogen concentrate substitution on thromboelastometry analysis in patients qualified for liver transplantation - preliminary results.
BACKGROUND
Dilutional coagulopathy might cause life-threatening hemorrhages in liver transplantation. Liver insufficiency is usually accompanied by alteration in fibrinogen (Fib) synthesis, which is one of the main clotting factors providing appropriate hemostasis. Intraoperative hemodilution results in further Fib concentration reduction enhancing coagulopathy and blood loss. Exogenous Fib substitution might prevent this.


METHODS
A prospective study with a control group was designed. The study group consists of patients with cirrhosis who qualified for liver transplantation. Inclusion and exclusion criteria were strictly established. The blood collected from participants was diluted up to 30% and 60% with crystalloid (saline) or colloid (hydroxyethyl starch) in 2 parallel series. The first series consisted of diluted blood, the second of diluted blood with Fib concentrate. Thromboelastometry tests were performed on every blood sample. After collecting data from the first 12 participants, we performed a preliminary analysis.


RESULTS
The maximum clot formation (MCF) in the EXTEM test decreased with progressive blood dilution in both study arms. The MCF values were lower than 35 mm in every diluted blood sample of the study group. The recovery of decreased MCF after Fib concentrate substitution was observed in both groups. The improvement in clot formation was also expressed as amplitude of clot firmness in the 10th minute (A10) in the FIBTEM test.


CONCLUSIONS
Clot formation is disturbed more profoundly by hemodilution in cirrhotic patients. Fib concentrate substitution might be effective in the management of dilutional coagulopathy.
Department of Anesthesiology and Intensive Care Unit, Medical University of Warsaw, Clinical Hospital Dzieciątka Jezus, Warsaw, Poland.
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B
Nicińska
Department of Anesthesiology and Intensive Care Unit, Medical University of Warsaw, Clinical Hospital Dzieciątka Jezus, Warsaw, Poland.
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J
Pluta
Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Clinical Hospital Dzieciątka Jezus, Warsaw, Poland.
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M
Kosieradzki
Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Clinical Hospital Dzieciątka Jezus, Warsaw, Poland.
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B
Lągiewska
Department of Surgical and Transplant Nursing, Medical University of Warsaw, Poland.
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D
Wasiak
Department of Anesthesiology and Intensive Care Unit, Medical University of Warsaw, Clinical Hospital Dzieciątka Jezus, Warsaw, Poland.
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T
Lazowski
Department of General Surgery and Transplantology, Transplantation Institute, Medical University of Warsaw, Clinical Hospital Dzieciątka Jezus, Warsaw, Poland.
A
A
Chmura
Department of Anesthesiology and Intensive Care Unit, Medical University of Warsaw, Clinical Hospital Dzieciątka Jezus, Warsaw, Poland. Electronic address: jtrzebicki@gmail.com.
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Trzebicki
D000328:Adult; D001778:Blood Coagulation Disorders / Q000188:drug therapy*; D001780:Blood Coagulation Tests; D016022:Case-Control Studies; D005260:Female; D005340:Fibrinogen / Q000096:biosynthesis / Q000494:pharmacology*; D006438:Hemodilution / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology; D006487:Hemostasis; D006490:Hemostatics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D066298:In Vitro Techniques; D008103:Liver Cirrhosis / Q000097:blood / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*
D006490:Hemostatics; D006895:Hydroxyethyl Starch Derivatives; D005340:Fibrinogen