title: An in vitro analysis of the effect of acidosis on coagulation in chronic disease states - a thromboelastograph study.
abstract: Thrombosis is a complication of many chronic illnesses. Chronic obstructive pulmonary disease (COPD) and diabetes mellitus are common medical conditions frequently associated with a hypercoagulable state. Acidaemia has been shown to reduce coagulation. COPD and diabetes mellitus during acute deterioration can present with a severe acidaemia. The impact of this acidaemia on coagulation is poorly studied. Patients presenting with a diagnosis of diabetic ketoacidosis or type II respiratory failure from COPD and a pH of less than 7.2 were included in our study. A coagulation screen and a thromboelastograph (TEG) were performed on admission and 24 hours later. The mean pH on admission was 7.07 and mean base excess was -16.3. The activated partial thromboplastin time was associated with pH change but remained within the normal range (26-41 s). All other coagulation and TEG parameters failed to show evidence of association (p>0.05). In the two models of non-haemorrhagic acidosis investigated, coagulation was not altered by the changes in pH. More work is needed to understand the complex relationship between factors affecting coagulation in individual disease processes.
authors.affiliation: Griffiths University, Department of Intensive Care, Logan Hospital, Meadowbrook, Australia.
authors.forename: Hayden
authors.initials: H
authors.lastname: White
authors.affiliation: Princess Alexandra Hospital, Woolloongabba, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Bird
authors.affiliation: Logan Hospital, Meadowbrook, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Sosnowski
authors.affiliation: University of Queensland, School of Population Health, Herston, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Jones
mesh_terms: D000138:Acidosis / Q000209:etiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology*; D002908:Chronic Disease; D016883:Diabetic Ketoacidosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology; D013916:Thrombelastography; D055815:Young Adult
keywords: COPD; DKA; ROTEM; TEG; acidosis; coagulation