Comparison of coagulation factors and blood loss between O and non-O blood types following hydroxyethyl starch infusion

Abstract

Background: Individuals with type O blood are more likely to have reduced factor VIII and von Willebrand factor levels compared to their non-O counterparts. Hydroxyethyl starch (HES), which is widely used for blood volume replacement, can induce coagulopathy. Therefore, we tested whether blood type O patients show more coagulopathy and blood loss than non-O patients after infusion of 6% HES.

Methods: Thirty-four non-O and 20 type O patients scheduled for posterior lumbar interbody fusion (PLIF) involving 3 vertebrae or less from June 2007 to August 2008 were enrolled. Fifteen ml/kg of 6% HES was administered during the operation. Coagulation profiles was checked at pre-infusion (T0), 5 min after the end of infusion (T1), 3 hr after the end of infusion (T2), and 24 hr after the end of infusion (T3). Bleeding was measured during and after surgery for 24 hours.

Results: Baseline factor VIII concentration was lower and aPTT was longer in type O patients compared to those of non-O patients. 6% HES infusion decreased most of the coagulation factors at T1 in both groups, which were recovered in a time dependent manner. Factor VIII and aPTT of blood type O patients fell off the normal range at T1. However, other coagulation factors, thromboelastography variables, and blood loss were not different between the groups.

Conclusions: Despite inborn low factor VIII which further decreased shortly after HES infusion, blood type O patients did not show more blood loss than non-O blood type after 15 ml/kg of HES infusion in PLIF surgery.

Keywords: Blood loss; Blood type; Coagulation; Factor VIII; Hydroxyethyl starch; Thromboelastography.

Fig. 1

Factor VIII was lower in the O group compared to the non-O group before HES infusion and throughout the study period. T0: preinfusion, T1: 5 min after infusion, T2: 3 hr after infusion, T3: 24 hr after the end of infusion. ^*P < 0.05 between Non-O and O groups. Error bars are SD.

Fig. 2

Comparison of proportional changes of hematocrit and Factor VIII after HES infusion at T1. There were no differences between hematocrit and Factor VIII in both groups. Error bars are SD.

Fig. 3

aPTT was prolonged in the O group compared to the non-O group before HES infusion and throughout the study period. T0: preinfusion, T1: 5 min after infusion, T2: 3 hr after infusion, T3: 24 hr after the end of infusion. ^*P < 0.05 between non-O and O groups. Error bars are SD.