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Isovolaemic hemodilution with gelatin and hydroxyethylstarch 130/0.42: effects on hemostasis in piglets
Lars Witt1, Wilhelm Alexander Osthaus, Wiebke Jahn
1Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany. witt.lars-henrik@mh-hannover.de
Insights
Artificial colloids like 4% gelatin (GEL) and hydroxyethyl starch (HES) can impair blood clot formation in children. Profound hemodilution with these colloids significantly impacts clot quality compared to isotonic crystalloid solution (ICS).
Area of Science:
- Pediatric Anesthesiology and Critical Care
- Hemostasis and Thrombosis Research
- Pharmacology of Fluid Resuscitation
Background:
- Artificial colloids are widely used for hemorrhagic shock management in pediatric patients.
- These fluid resuscitation agents have been shown to interfere with normal blood coagulation processes.
- Understanding the specific impact of different colloid types on pediatric clot formation is crucial for patient safety.
Purpose of the Study:
- To investigate the effects of isovolemic hemodilution with artificial colloids (4% gelatin and hydroxyethyl starch) versus isotonic crystalloid solution on clot formation in a pediatric animal model.
- To compare the impact of moderate and profound hemodilution on hemostatic function.
Main Methods:
- Fifteen piglets underwent controlled hemorrhage (40 ml·kg⁻¹).
- Blood loss was replaced with either 4% gelatin (GEL), hydroxyethyl starch 130/0.42 (HES), or isotonic crystalloid solution (ICS) via isovolemic hemodilution.
- Clot formation and platelet function were assessed using Thrombelastometry (ROTEM®) and Multiple Electrode Impedance Aggometry (Multiplate®) at different stages of hemodilution.
Main Results:
- Moderate hemodilution (10-20 ml·kg⁻¹ replacement) showed no significant differences in clot formation among the ICS, GEL, and HES groups.
- Profound hemodilution (40 ml·kg⁻¹ replacement) revealed significant impairment of clot formation with both GEL and HES compared to ICS (P < 0.05).
- No significant difference in clot impairment was observed between GEL and HES during profound hemodilution.
Conclusions:
- Moderate isovolemic hemodilution with ICS, GEL, or HES does not differentially impair clot formation in this pediatric model.
- Profound hemodilution (over 50% estimated blood volume) using GEL or HES significantly impairs clot formation compared to ICS.
- Clinicians should consider the potential for impaired hemostasis when administering high volumes of synthetic colloids in pediatric patients experiencing hemorrhagic shock.
Objectives:
Artificial colloids, frequently used to prevent hemorrhagic shock in children, impair blood coagulation. To determine the impact of acute isovolaemic hemodilution with artificial colloids on clot formation, we conducted an experimental study in a pediatric animal model.
Methods:
Fifteen piglets underwent hemorrhage by withdrawing 40 ml·kg(-1) of blood volume in steps of 10 ml·kg(-1) each within 1 hour. After each withdrawal, the blood loss was randomly compensated by administering 4% gelatin (GEL) or hydroxylethyl starch 130/0.42 (HES) in a ratio of 1 : 1, or isotonic crystalloid solution (ICS) in a ratio of 1 : 4 for isovolaemic hemodilution. Quality of clot formation and platelet function was measured using Thrombelastometry (ROTEM(®)) and Multiple electrode impedance aggregometry (Multiplate(®)) after 10, 20, and 40 ml·kg(-1) blood replacement.
Results:
Moderate hemodilution (10-20 ml·kg(-1) blood replacement) caused no significant differences among groups (e.g. INTEM(®)-MCF after 20 ml·kg(-1) blood replacement (ICS vs GEL vs HES, P > 0.05). Profound hemodilution with 40 ml·kg(-1) blood replacement showed a significant difference between ICS and both colloids (P < 0.05), but no significant differences between GEL and HES.
Conclusions:
Impairment of clot formation by moderate isovolaemic hemodilution did not significantly differ between ICS, GEL, and HES. Profound hemodilution of more than 50% of the estimated blood volume with GEL and HES caused significant impairment of clot formation in comparison to ICS and has to be considered when using high amounts of these synthetic colloids.
