In Vitro Evaluation of the Effect of Haemodilution with Dextran 40 on Coagulation Profile as Measured by Thromboelastometry and Multiple Electrode Aggregometry

Abstract

We evaluated the effects of haemodilution with either dextran 40 or 0.9% normal saline on coagulation in vitro using rotational thromboelastometry (ROTEM®, Pentapharm Co., Munich, Germany) and multiple electrode aggregometry (Multiplate® Platelet Function Analyser, Dynabyte, Munich, Germany). Venous blood samples obtained from 20 healthy volunteers were diluted in vitro with dextran 40 or normal saline by 5%, 10% and 15%. Fibrinogen concentration, ROTEM-EXTEM® (screening test for the extrinsic coagulation pathway), FIBTEM® (an EXTEM-based assay of the fibrin component of clot) parameters including coagulation time, clot formation time, alpha angle, maximum clot firmness and lysis index were measured in the undiluted sample and at each level of haemodilution. Dextran 40 at 15% haemodilution significantly prolonged coagulation time, clot formation time and significantly decreased the alpha angle and maximal clot firmness (EXTEM amplitude at five minutes [A5] and ten minutes [A10]) compared with normal saline. The FIBTEM assay (maximal clot firmness and FIBTEM A5 and A10) showed a marked decrease in maximal clot firmness at all dilutions suggesting impaired fibrinogen activity and a risk of bleeding. Multiple electrode aggregometry did not demonstrate any platelet dysfunction. Haemodilution with dextran 40 causes significant impairment in clot formation and strength compared to saline haemodilution and undiluted blood. At the levels of in vitro haemodilution designed to reflect the clinical use of dextran infusions, no significant fibrinolysis or platelet inhibition was observed.

The Effects of Haemodilution with Succinylated Gelatin Solution on Coagulation in Vitro as Assessed by Thromboelastometry and Impedance (Multiple Electrode) Aggregometry

“…A P-value of <0.05 was considered statistically significant. Based on data from previous studies 8,9,11,12 , ten subjects were estimated to provide a power of 80% at a five percent significance level to detect a 20% difference in thromboelastometric parameters from control samples.…”

“…The aims of this study were to evaluate the direct effects of SG on coagulation and to distinguish between the effects of gelatin and the effect of haemodilution per se. We recently published two studies on the effect of haemodilution with dextran 40 8 and albumin 9 . In this study, we used a similar methodology (rotational thromboelastometry) (ROTEM®, Pentapharm CO, Munich, Germany) and platelet function using multiple electrode aggregometry (Multiplate® Platelet Function Analyser, Dynabyte, Munich, Germany) to investigate the in vitro effects on coagulation of progressive haemodilution with 4% SG solution with equivalent dilutions with normal saline (NS) 0.9%.…”

Dextran Used in Blood Transfusion, Hematology, and Pharmaceuticals: Biosynthesis of Diverse Molecular-Specification-Dextrans in Enzyme-Catalyzed Reactions

“…Dextran-70 and 40 preparations, with molecular weights of 70 and 40 kDa, were recommended to manage shock or impending shock caused by hemorrhage, burns, and trauma [2,3,6]. Kam et al [7] used dextran-40 in vitro to evaluate the effect of hemodilution on the coagulation profile, where the thromboelastometry and multiple electrode aggregometry methods measured the test samples. The use of albumin as an alternative might be beneficial in patients suffering from septic shock; however, the cost of clinical-grade albumin is high.…”

Dextran of Diverse Molecular-Configurations Used as a Blood-Plasma Substitute, Drug-Delivery Vehicle and Food Additive Biosynthesized by Leuconostoc, Lactobacillus and Weissella

“…In an investigation, dextran-40 was used to accomplish an in vitro evaluation of haemodilution affecting the coagulation profile. The analytical assays were performed using thrombo-elastometry and multiple electrode aggregometry [21]. Although the application of albumin in patients with septic shock is helpful, the two factors that affect its use are the high cost of clinical-grade albumin and its regulated availability.…”