The In Vitro Effects Of Fibrinogen Concentrate And Factor â…§ On Dilutional Coagulopathy Induced By Different Fluids

Background: Previous investigations have shown that the administration of massivefluids, causes coagulopathy significantly through dilution. In this in vitro study, weassessed the effect on blood coagulation of50%dilution with different fluids andinvestigated reversibility by replacement of factor VIII (FVIII), fibrinogen(FBG), and thecombination of FBG and F VIII, so as to provide some information for clinic work.Methods: Using the blood of18patients scheduled for elective operation, under theconstant37℃temperature, blood was diluted by50%using Lactated Ringer’s Solution,modified gelatin and hydroxyethyl starch130/0.4. Diluted blood samples were incubatedwith two different doses of fibrinogen concentrate, FVIII concentrate, and the combinationof both, in concentrations corresponding to4g or8g fibrinogen and1400IU F VIII inadults. Using Thrombelastograph (TEG), blood samples were analyzed at baseline (0%dilution), after dilution and after supplementation.Results: TEG parameters did not change much in group RL. Decreased MA, andprolonged K were observed in this group. Supplementation of low dose of fibrinogenrestored TEG parameters in group RL. But the K value was over shorter, lower thannormal range. Supplementation of high dose of fibrinogen, all the TEG parameters exceptvalue R were out of the normal range. Decreased and MA, and prolonged K wereobserved in group GEL after dilution. However,Angle and K were still within thenormal range. Supplementation of low dose or high dose of fibrinogen both restored allTEG parameters in group GEL. TEG parameters changed most pronounced in group HES with decreased and MA, and prolonged K. The TEG data such as MA and K was farbeyond the normal range in group HES. Supplementation of low dose of fibrinogen cannot restore the TEG parameters in group HES, while the supplementation of high dose offibrinogen can. FVIII alone also can not correct coagulation function caused by dilutioninto normal range.FVIII also can not enhance the effect of fibrinogen.Conclusions: Coagulation function was impaired after50%dilution by all3colloids, andcoagulopathy was most obvious with hydroxyethyl starch. The effect of fibrinogendepends on the kind of the fluid and the dose of fibrinogen. The effect of fibrinogen makeparts of TEG parameters of RL beyond normal range. Coagulopathy induced by GEL wassignificantly more reversible than HES. This effect of fibrinogen can not enhanced byadding FVIII. FVIII alone also can not correct coagulation function to normal range.