title: Functional capacity of reconstituted blood in 1:1:1 versus 3:1:1 ratios: a thrombelastometry study.
abstract: BACKGROUND
  Different transfusion ratio concepts of packed red blood cells (pRBCs), fresh frozen plasma (FFP) and platelets (PLTs) have been implemented in trauma care, but the optimal ratios are still discussed. In this study the hemostatic potential of two predefined ratios was assessed by using an in vitro thrombelastometric approach. Furthermore, age effects of reconstituted blood were analyzed.
  
  
  METHODS
  Whole blood (WB) of voluntary donors was separated into pRBCs, FFP and PLTs and reconstituted into the ratios 1:1:1 and 3:1:1 at day 1, 4, 14, and 24. Standard blood count, electrolytes and coagulation proteins were quantified. The functional coagulation in ratio- and age-specific groups was evaluated using rotational thromboelastometry (ROTEM).
  
  
  RESULTS
  Several coagulation factors reduced significantly in the 3:1:1 ratio and were consistent with increased INR, decelerated clot formation times and A10 (amplitude 10 minutes after clotting time (CT)), flattened α-angle during the EXTEM and diminished MCF for distinct time points during the INTEM, FIBTEM and APTEM assays. With rising age of pRBCs the pH, sodium and potassium reached non-physiological levels.
  
  
  CONCLUSIONS
  Under standardized in vitro conditions the higher amount of pRBCs in the 3:1:1 ratio diluted coagulation factors significantly on the expense of its functional coagulation capacity as revealed by ROTEM results. Thus, the coagulation functionality of the 1:1:1 ratio predominated.
authors.affiliation: Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. arne.driessen@uni-wh.de.|Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. arne.driessen@uni-wh.de.
authors.forename: Arne
authors.initials: A
authors.lastname: Driessen
authors.affiliation: Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. nadine.schaefer@uni-wh.de.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schäfer
authors.affiliation: Institute of Transfusion Medicine Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Cologne (Germany), Ostmerheimer Str. 200, D-51109, Cologne, Germany. bauerfeindu@kliniken-koeln.de.
authors.forename: Ursula
authors.initials: U
authors.lastname: Bauerfeind
authors.affiliation: Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. sigune.peiniger@web.de.
authors.forename: Sigune
authors.initials: S
authors.lastname: Kaske
authors.affiliation: Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. carolin.fromm-dornieden@uni-wh.de.
authors.forename: Carolin
authors.initials: C
authors.lastname: Fromm-Dornieden
authors.affiliation: Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. ewa.stuermer@uni-wh.de.
authors.forename: Ewa K
authors.initials: EK
authors.lastname: Stuermer
authors.affiliation: Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, D-51109, Cologne, Germany. marc.maegele@t-online.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
mesh_terms: D001780:Blood Coagulation Tests; D001792:Blood Platelets / Q000502:physiology; D001803:Blood Transfusion / Q000379:methods*; D004912:Erythrocytes / Q000502:physiology; D006801:Humans; D066298:In Vitro Techniques; D019934:International Normalized Ratio; D010949:Plasma / Q000502:physiology; D013916:Thrombelastography