Comparison of whole blood versus red blood cells and plasma to correct trauma-induced coagulopathy ex vivo

被引:0
|
作者
Rossetto, Andrea [1 ,2 ]
Vulliamy, Paul [1 ,2 ]
Huish, Sian [3 ]
Cardigan, Rebecca [3 ,4 ]
Green, Laura [1 ,2 ,5 ]
Davenport, Ross [1 ,2 ]
机构
[1] Queen Mary Univ London, Blizard Inst, Ctr Trauma Sci, London, England
[2] Barts Hlth Natl Hlth Serv Trust, London, England
[3] Natl Hlth Serv Blood & Transplant, Component Dev Lab, Cambridge, England
[4] Univ Cambridge, Dept Haematol, Cambridge, England
[5] Natl Hlth Serv Blood & Transplant, Transfus Med, London, England
关键词
hemostasis; platelet aggregation; resuscitation; thromboelastometry; trauma; whole blood; THROMBIN GENERATION; COMPONENT THERAPY; PLATELET-FUNCTION; TRANSFUSION; THROMBOELASTOMETRY; FIBRINOLYSIS; MORTALITY; TISSUE; ASSAY;
D O I
10.1111/trf.18143
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Early resuscitation is based on platelet-poor components such as red blood cells and plasma (RBC + P), contributing to platelet dilution and worsening of trauma-induced coagulopathy (TIC). We aimed to compare the ability of cold-stored whole blood (WB) versus RBC + P as a single component to correct TIC. Study Design and Methods: Blood samples were collected on admission from trauma patients who required activation of the major hemorrhage protocol at a single UK major trauma center in 2021/2022. Samples were spiked ex vivo with volumes equivalent to two, four, or eight units of WB or RBC + P stored for a maximum of 2 weeks. Thromboelastometry, platelet counting, and multiple electrode aggregometry (MEA) were performed. Results: Samples from 20 adult trauma patients were analyzed. Median age was 32 years (27-42), 89% were male, 70% had platelet dysfunction (tissue factor-activated ROTEM [EXTEM]-tissue factor-activated ROTEM with cytochalasin D [FIBTEM] clot amplitude at 5 min [A5] <= 30 mm), 65% were coagulopathic (EXTEM A5 <= 40 mm), and 42% died. EXTEM-FIBTEM A5 was higher following spiking with WB than RBC + P (33 mm, 26-33, vs. 27 mm, 24-30, p < .001). WB-spiking corrected platelet dysfunction in 2 patient samples out of 20, whereas RBC + P increased the frequency of platelet dysfunction (1/20 sample) and TIC (4/20 samples). RBC + P was associated with a dose-dependent deterioration in rotational thromboelastometry (ROTEM) clot strength and dynamics, platelet count, and aggregation in response to multiple agonists compared with WB-spiking, which maintained or partially corrected these abnormalities. Conclusion: Compared with RBC + P, WB better preserves ex vivo platelet-related ROTEM parameters, platelet count, and aggregation, but does not fully correct these common derangements of TIC.
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页数:13
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