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. 2015 Jan 9:23:2.
doi: 10.1186/s13049-014-0080-0.

Functional capacity of reconstituted blood in 1:1:1 versus 3:1:1 ratios: a thrombelastometry study

Arne Driessen  1   2 , Nadine Schäfer  3 , Ursula Bauerfeind  4 , Sigune Kaske  5 , Carolin Fromm-Dornieden  6 , Ewa K Stuermer  7 , Marc Maegele  8
Affiliations

Functional capacity of reconstituted blood in 1:1:1 versus 3:1:1 ratios: a thrombelastometry study

Arne Driessen et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Introduction: 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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
Procedure of blood separation and reconstitution as well as subsequent experiments.
Figure 2
Figure 2
Kinetics of hemostasis as demonstrated by a viscoelastic test (ROTEM, Tem Innovations GmbH).
Figure 3
Figure 3
Quantitative cumulative factor quantity (summing up coagulation factors FII, FV, FVII, FVIII, F IX, FX, FXI, FXII, FXIII) and INR of the WB, 1:1:1 and 3:1:1 groups. Levels are represented as mean and standard deviation. Bars are depicted as dotted (WB), light grey (1:1:1) and dark grey (3:1:1). Significances were observed at *p < 0.05; **p < 0.01; ***p < 0.001.
Figure 4
Figure 4
Functional characterization of coagulation via ROTEM analysis. The α-angle, amplitude after 10 minutes (A10) and maximum clot firmness (MCF) after 30 minutes of the EXTEM, INTEM, FIBTEM, and APTEM assays are represented as mean and standard deviation. Bars are depicted as dotted (WB), light grey (1:1:1) and dark grey (3:1:1). Significances were observed at *p < 0.05; **p < 0.01; ***p < 0.001. Age differences (p < 0.05) were indicated with the lowercases a (day 1 ↔ 4), b (day 1 ↔ 14), c (day 1 ↔ 24), d (day 4 ↔ 14), e (day 4 ↔ 24), and f (day 14 ↔ 24), respectively.
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