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Hypothermia Induced Impairment of Platelets: Assessment With Multiplate vs. ROTEM-An In Vitro Study
Bernd Wallner1,2,3, Bettina Schenk4, Peter Paal5
1Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Frontiers in Physiology
|April 15, 2022
Summary
Hypothermia significantly impairs blood clotting by prolonging clotting times and slowing clot formation, as measured by ROTEM. While MULTIPLATE shows reduced platelet function with cooling, ROTEM does not adequately detect these platelet changes.
Area of Science:
- Hematology
- Physiology
- Medical Technology
Background:
- Hypothermia is a known risk factor for coagulopathy, affecting hemostasis.
- Quantitative assessment of hypothermia's impact on coagulation is crucial for clinical management.
- Rotational thromboelastometry (ROTEM) and multiple-electrode aggregometry (MULTIPLATE) are advanced diagnostic tools for coagulation analysis.
Purpose of the Study:
- To identify and characterize hypothermia-associated coagulopathy.
- To compare changes in coagulation during mild to severe hypothermia using ROTEM and MULTIPLATE.
- To evaluate the sensitivity of ROTEM and MULTIPLATE in detecting temperature-induced hemostatic alterations.
Main Methods:
- Whole blood samples from 18 healthy volunteers were analyzed.
- Samples were tested at temperatures ranging from 37°C down to 13.7°C.
- Coagulation was assessed using ROTEM (ExTEM, InTEM, FibTEM) and MULTIPLATE (ASPI, TRAP, ADP) assays at corresponding temperatures.
Main Results:
- ROTEM showed significantly prolonged clotting times (CT) and clot formation times (CFT) with decreasing temperatures.
- The alpha angle in ROTEM decreased significantly at lower temperatures, indicating impaired clot kinetics.
- MULTIPLATE demonstrated a linear reduction in platelet function (AUC) with decreasing temperatures, which ROTEM did not fully capture.
Conclusions:
- Hypothermia significantly impairs coagulation by prolonging clotting time and reducing clot formation velocity, as detected by ROTEM.
- Platelet function is linearly reduced with decreasing temperatures, confirmed by MULTIPLATE.
- ROTEM may underestimate the severity of hypothermia-induced platelet dysfunction compared to MULTIPLATE.
