Correction of blood coagulation dysfunction and anemia by supplementation of red blood cell suspension, fresh frozen plasma, and apheresis platelet: Results of in vitro hemodilution experiments

• Published in: Journal of critical care 2015-02, Vol.30 (1), p.220.e1-220.e12
• Main Authors: Li, Ling, BS Med Tech, Yang, Jiangcun, PhD, Sun, Yang, PhD, Dang, Qianli, PhD, Xu, Cuixiang, PhD, Chen, Ping, BS Med Tech, Ma, Ting, BS Med Tech, Ren, Jiangkang, MS
• Format: Article
• Language: English
• Subjects: Anemia - etiology; Anemia - therapy; Blood; Blood Coagulation - physiology; Blood Coagulation Disorders - etiology; Blood Coagulation Disorders - therapy; Blood Component Removal - methods; Blood platelets; Blood Platelets - physiology; Blood Transfusion - methods; Blood transfusions; Coagulation; Critical Care; Dilution; Disturbance of blood coagulation; Erythrocyte Transfusion - methods; Erythrocytes; Fresh frozen plasma; Hemodilution; Hemodilution - adverse effects; Hemodilution - methods; Humans; In Vitro Techniques; Mortality; Plasma; Platelet Count; Red blood cells suspension; Studies; Thrombelastogram; Thrombelastography
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.09.019

Abstract Purpose This study aimed to determine the optimal composition and timing for the administration of blood supplements during in vivo blood transfusion with red blood cells suspension (pRBC), fresh frozen plasma (FFP), and apheresis platelet (PLT) administered for the correction of anemia and coagulation dysfunction caused by in vitro hemodilution. Materials and methods We collected blood samples from 24 healthy volunteers and prepared various dilutions of whole blood with normal saline: 9:1, 8:2, 7:3, 6:4, 5:5, 4:6, 3:7, 2:8, and 1:9. The diluted blood samples were then supplemented with blood components at various proportions and then analyzed to determine the values of the routine blood indices, coagulation indices, and thromboelastogram measures. Results At hemodilutions of 40%, 50%, and 60%, the hemoglobin, coagulation indices, and platelet number and function reached critical levels, necessitating supplementation with pRBC, FFP, and PLT, respectively. When hemodilution was 90%, the supplementation required was approximately 1:1.3:0.9 of pRBC/FFP/PLT. Conclusion The use of pRBC, FFP, and PLT in appropriate proportions can correct the blood coagulation dysfunction and anemia caused by in vitro hemodilution, and these proportions can be used as guidelines for in vivo massive transfusion.