title: Haemostasis monitored in stored red blood cells, plasma and platelet concentrates in the proportion of 4 :  4 :  1 diluted with crystalloids and colloids.
abstract: The aim of this in-vitro study was to evaluate haemostasis analysed with thromboelastometry and blood gas and blood count variables, in stored blood components and the effects after dilution with Ringer[Combining Acute Accent]s acetate, albumin and hydroxyethyl starch (HES). Aliquots from stored red blood cells, plasma and platelet concentrates were mixed in the proportion of 4 : 4 : 1 and analysed with rotational thromboelastometry (ROTEM), blood count [haemoglobin (Hb), haematocrit, platelet count] and blood gas (pH, calcium, sodium, potassium, glucose levels). The blood mix was thereafter diluted 20 and 33% with Ringer's acetate, albumin or HES. The stored blood component mix in a ratio of 4 : 4 : 1 had a low pH (7.11 ± 0.03, mean ± standard deviation), nonmeasurable calcium level, and high concentrations of sodium, potassium and glucose but ROTEM curves within normal range after recalcification. With Ringer's acetate dilution, the ROTEM variables changed almost linearly with increasing dilution volume. When albumin was used in the 33% dilution, the clot firmness of the fibrin clot (FibTEM) was further reduced, and with HES dilution, there was a pronounced impairment. The stored blood mix had a low pH and calcium level, both of which might have a significant influence on the coagulation process but normal ROTEM curves after recalcification. Dilution with Ringer's acetate and albumin resulted in moderate deterioration, while dilution with HES showed severely impaired haemostasis.
authors.affiliation: aDepartment of Medicine, Division of Hematology, Coagulation Unit, Karolinska Institutet and Karolinska University Hospital bDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet cDepartment of Medicine, Division of Hematology, Karolinska Institutet and Karolinska University Hospital dDepartment of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital eDepartment of Anaesthesiology and Intensive Care, Karolinska University Hospital and Karolinska Institutet fDepartment of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Ågren
authors.forename: Gustaf
authors.initials: G
authors.lastname: Edgren
authors.forename: Daniela
authors.initials: D
authors.lastname: Ambrosio
authors.forename: Gunilla
authors.initials: G
authors.lastname: Gryfelt
authors.forename: Anders
authors.initials: A
authors.lastname: Östlund
authors.forename: Agneta
authors.initials: A
authors.lastname: Wikman
mesh_terms: D001784:Blood Gas Analysis; D001792:Blood Platelets / Q000166:cytology* / Q000378:metabolism; D001793:Blood Preservation / Q000379:methods*; D000077324:Crystalloid Solutions; D004906:Erythrocyte Count; D004912:Erythrocytes / Q000166:cytology* / Q000378:metabolism; D006400:Hematocrit; D006438:Hemodilution; D006487:Hemostasis; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000378:metabolism; D007552:Isotonic Solutions / Q000378:metabolism; D010949:Plasma / Q000378:metabolism*; D010952:Plasma Substitutes / Q000378:metabolism; D010976:Platelet Count; D012709:Serum Albumin / Q000378:metabolism; D013916:Thrombelastography
chemical_list: D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; C028570:Ringer's acetate; D012709:Serum Albumin