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Hemostasis and hemodilution: a quantitative mathematical guide for clinical practice
Kai Singbartl1, Petra Innerhofer, Jens Radvan
1*Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster, Münster, Germany; †Klinik für Anästhesiologie und Intensivmedizin, Leopold Franzens-Universität Innsbruck, Innsbruck, Austria; ‡Institut für Biomedizinische Technologien, Rheinisch-Westfälische Technische Hochschule Aachen, Germany; and §Klinik für Anästhesie, Krankenhaus Bethanien, Moers, Germany.
Hemostasis, particularly plasma fibrinogen levels, can limit hemodilution extent. Combining acute normovolemic hemodilution with artificial blood substitutes may negate benefits by necessitating hemostasis stabilization.
Area of Science:
- Anesthesiology
- Hematology
- Medical Engineering
Background:
- Hemostasis changes during hemodilution are not fully understood.
- Artificial blood substitutes (ABS) add complexity to managing hemodilution.
- Maximal allowable blood loss (MABL) is critical for patient safety.
Purpose of the Study:
- To quantitatively analyze hemostasis during hemodilution using a mathematical model.
- To determine the primary limiting factors of hemodilution.
- To assess the impact of ABS on hemodilution limits.
Main Methods:
- Developed and validated a mathematical model for hemostasis during hemodilution.
- Calculated MABL based on hematocrit, platelet, and fibrinogen concentrations.
- Analyzed patient data (n=204) and simulated hemodilution scenarios with ABS.
Main Results:
- Platelet concentration rarely limits hemodilution (<2% of patients).
- Plasma fibrinogen concentration (< or =100 mg/dL) frequently limits hemodilution, especially with lower initial levels (<300 mg/dL).
- Combining acute normovolemic hemodilution (ANH) with ABS increases the frequency of fibrinogen limitation.
Conclusions:
- Hemostasis, particularly plasma fibrinogen, is a significant limiting factor in hemodilution.
- The use of ABS with ANH may require blood products for hemostasis, undermining the procedure's goals.
- A validated mathematical model provides quantitative insights into hemodilution and hemostasis.