[Dilutional coagulopathy: development, diagnostic options and management].

Area of Science:

• Anesthesiology and Critical Care Medicine
• Hematology

Context:

• Acute major blood loss management often involves crystalloids, colloids, and red blood cells, leading to dilution of plasma clotting factors.
• Consumption coagulopathy frequently accompanies dilutional coagulopathy during massive transfusions.
• Standard coagulation tests and blood loss formulas may be insufficient in massive transfusion scenarios.

Purpose:

• To highlight the challenges in managing coagulopathy during massive blood loss when fresh frozen plasma is unavailable.
• To emphasize the utility of point-of-care systems like thrombelastography for assessing coagulation status.
• To discuss therapeutic strategies and the need for further research in coagulation management.

Summary:

• Massive transfusion dilutes coagulation factors, causing consumption and dilutional coagulopathy, with fibrinogen levels critically affected.
• Artificial colloids, like hydroxyethyl starch, can further impair fibrin polymerization.
• Fresh frozen plasma is the primary therapy, but coagulation factor concentrates are alternatives when plasma is insufficient; however, clinical data on both is limited.

Impact:

• Point-of-care testing offers advantages over traditional methods for real-time coagulation assessment.
• Fibrinogen levels are critical indicators of coagulopathy in this setting.
• Further clinical studies are essential to establish evidence-based guidelines for managing massive blood loss-induced coagulopathy.