Effects of Blood Components and Whole Blood in a Model of Severe Trauma-Induced Coagulopathy

Abstract

Background: Plasma resuscitation ameliorates hyperfibrinolysis (HF) and trauma-induced coagulopathy (TIC). However, the use of other blood components to reduce HF has not been evaluated. Therefore, our aim was to determine the effect of individual blood components and whole blood (WB) on an in vitro model of severe HF/TIC.

Methods: A "TIC" solution was made with 1:1 dilution of WB with saline and exacerbated with tissue plasminogen activator (tPA). Components were added in proportions equivalent to the thromboelastography (TEG) based goal-directed resuscitation used at our institution. Whole blood was added at proportions equal to what has been transfused in injured patients. Samples (n = 9) underwent citrated native and tPA-challenge (75 ng/mL) TEG with analysis of R-time, angle, MA, and LY30. Statistical analyses were completed employing the nonparametric Kruskal-Wallis and Dunn's multiple comparisons tests.

Results: TIC solution, when compared to control, had a decrease in clot strength (MA 41 mm versus 51.5 mm, P < 0.01). The addition of tPA resulted in a severe coagulopathy (MA 24.5 mm versus 41 mm and LY30 52.8% versus 2.4%, P < 0.03 for all). The addition of 4U of WB improved clot strength compared to TIC + tPA (P = 0.03). No individual blood component resulted in improved fibrinolysis (P > 0.7). Cryoprecipitate improved R-time (7.5 versus 11.9 min, P < 0.01), angle (56.8 versus 30.2°) and MA (49 mm versus 36.25 mm), while platelets improved MA (44 mm versus 36.25 mm) compared to TIC + tPA (P < 0.03 for all).

Conclusions: No single blood component or volume of whole blood led to attenuation of tPA-mediated fibrinolysis in an in vitro model of TIC. Cryoprecipitate was the most effective at improving coagulation function.

Keywords: Blood component therapy; Hyperfibrinolysis; Trauma-induced coagulopathy; Whole blood.

Figure 1:

Schematic representation of control groups and experimental groups. TIC = trauma induced coagulopathy, tPA = tissue plasminogen activator, and WB = whole blood

Figure 2:

The addition of cryoprecipitate to a TIC+tPA solution led to enhanced clot initiation. The addition of plasma or platelets had a similar clot initiation compared to a TIC+tPA solution. Cryoprecipitate also is shown to have superior clot initiation compared to whole blood control *p<0.01 compared to TIC+tPA, †p<0.01 compared to control

Figure 3:

The addition of cryoprecipitate to a TIC+tPA solution led to enhanced dynamics of clot formation. Angle was enhanced compared to whole blood control. The addition of plasma or platelets had a similar angle compared to a TIC+tPA solution. *p<0.01 compared to TIC+tPA, †p<0.01 compared to control

Figure 4:

The addition of cryoprecipitate and platelets to a TIC+tPA solution led to enhanced clot strength. The addition of plasma had a clot strength compared to a TIC+tPA solution. *p<0.03 compared to TIC+tPA, †p<0.01 compared to control

Figure 5:

Compared to a TIC+tPA solution, there was not a difference in fibrinolysis when plasma, platelets, nor cryoprecipitate were added. *p<0.01 compared to control