Simple clotting test to detect procoagulant abdominal swabs

Abstract

During surgical procedures, abdominal swabs are routinely used to adsorb blood from the operation field and for the retention of tissues and organs. Due to the material characteristics, abdominal swabs exhibit a slight procoagulant activity, which is usually desirable and mostly harmless. However, during cardiac surgery with heart-lung machine (HLM) support, abnormal clot formation may result in life-threatening thromboembolic complications. Therefore, a simple clotting test (SCT) allowing in vitro detection of abdominal swabs with elevated hypercoagulant potency in the presence of heparinized human blood was developed and validated. In order to establish a SCT, heparinized human blood from 100 donors was incubated with five different cotton abdominal swabs for 30 min at 37 °C and then macroscopically analyzed. In a second study, 10 other swabs were screened with the established SCT (n=11) to confirm its suitability. Scanning electron microscopy, measurements of activated clotting times and thrombin-antithrombin were further performed. In the SCT, the results are dichotomized as negative (no detectable blood clot) and positive (blood clot formation). In the first study, three of the five tested abdominal swabs exhibited hypercoagulant potency in at least 25% of the donors. Calculations using the binomial distribution showed that blood of 11 donors is needed for routine testing with the SCT, which was confirmed in the second study using another 10 swabs. The established SCT can be used for detection of abdominal swabs with an elevated procoagulant potency, thereby minimizing the risk of thromboembolic complications during cardiac surgery with HLM support.

Fig. 1

a Representative macroscopic images of five different cotton abdominal swabs tested in study 1 after incubation with heparinized human whole blood of 3 donors in the SCT. b Representative SEM images of the five abdominal swabs after incubation with whole blood for 30 min at 37 °C; magnification ×2,500. c Likelihood of detecting a positive swab in dependence of expected proportion of positive donors (0–100 %) and amount of donors (5; 7; 9; 11). The dotted lines indicated that in order to detect a swab to which 25 % of donors react with 95 % likelihood 11 donors need to be tested