These data have been presented in part as posters at the Annual Congress of the American Society of Anesthesiologists, San Francisco 2000, as well as at the Association of Anesthetists' Annual Scientific Meeting, Birmingham 2000.
Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline-based hetastarch solution and lactated Ringer's solution*
Article first published online: 1 OCT 2002
Volume 57, Issue 10, pages 950–955, October 2002
How to Cite
Roche, A. M., James, M. F. M., Grocott, M. P. W. and Mythen, M. G. (2002), Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline-based hetastarch solution and lactated Ringer's solution. Anaesthesia, 57: 950–955. doi: 10.1046/j.1365-2044.2002.02707.x
- Issue published online: 1 OCT 2002
- Article first published online: 1 OCT 2002
- Accepted: 15 April 2002
- Blood: coagulation;
- Fluid balance: intravenous fluids;
- Measurement techniques: TEG
The hydroxyethyl starches are a group of compounds that has been associated with impairment of coagulation when large volumes are administered. The thrombelastograph® is commonly used to assess point-of-care whole blood coagulation. Little is known about the dose–response relationships of haemodilution, and it is reasonable to assume that a linear association exists. This may not be the case with altered electrolyte compositions of the fluids used for haemodilution. We have therefore conducted an in vitro study of haemodilution of human whole blood using lactated Ringer's solution and two high molecular weight hetastarches, one in a balanced salt solution, the other in a 0.9% saline solution. The thrombelastograph®, commonly used for the assessment of the coagulation effects of synthetic colloids, was used as the coagulation assessment device. Serial haemodilution with hetastarch in a balanced salt solution demonstrated a biphasic response (of r-times and k-times, as well as alpha angles), with haemodilution in the 20–40% range causing enhanced coagulation, and higher degrees of dilution causing a decrease in overall coagulation performance. A similar picture was observed with lactated Ringer's solution, but only significantly so in alpha angles. Hetastarch in saline did not display this initial increased coagulability at mild to moderate dilutions. This biphasic response of lactated Ringer's solution and hetastarch in a balanced salt solution reflects the complex interaction of fluids and the coagulation system, and that these effects cannot be attributed to simple haemodilution. On the other hand, there was a linear decrease in maximum amplitude with haemodilution. Maximum amplitude was particularly affected by both starches, which is an expected finding in view of the known interaction between the hydroxyethyl starches and von Willebrand's factor.