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CARDIOVASCULAR ANESTHESIA

The Effects of In Vitro Hemodilution with Gelatin, Hydroxyethyl Starch, and Lactated Ringer’s Solution on Markers of Coagulation: An Analysis Using SONOCLOT^TM

Christoph Konrad, MD^*, Timo Markl, CM^*, Guido Schuepfer, MD^*, Helmut Gerber, MD Prof.^*, and Markus Tschopp, LT

*Department of Anesthesiology and Intensive Care and Hematology Laboratories, Kantonsspital, Lucerne, Switzerland

Address correspondence and reprint requests to Christoph Konrad, MD, Department of Anesthesiology and Intensive Care, Kantonsspital, CH-6000 Lucerne 16, Switzerland. Address e-mail to Fieber_Konrad{at}Compuserve.com

Blood-saving strategies have recently been established to avoid allogeneic transfusion during surgery or after trauma. This includes an expanding use of crystalloids and colloids. These solutions interfere with coagulation systems, but quantitative measurements are still lacking. The SONOCLOT^TM (Sienco Company, Morrison, CO) analysis (SCT), a viscoelastic test, measures clot formation and includes information on the cellular, as well as the plasmatic coagulation, system. To quantify hemodilutional effects on in vitro coagulation, we studied gelatin (G), hydroxyethyl starch 6% (HES; molecular weight 450,000), and lactated Ringer’s solution (RL) in 33% and 66% dilutions measuring routines laboratory and SCT variables. Hemodilution with RL tended to increase in vitro coagulability. Among the tested colloids, G had the least impact on markers of coagulation. G33% did not differ significantly from the undiluted control group. HES had the largest impact on markers of coagulation compared with G and RL. In conclusion, SCT provides a fast and easy to perform bedside test to quantify in vitro hemodilution.

Implications: The effects of progressive hemodilution on coagulation are difficult to measure. SONOCLOT analyses provide an easy to perform test with fast information on cellular and plasmatic coagulation properties. Among colloids, hydroxyethyl starch has the largest impact on markers of coagulation compared with gelatin or lactated Ringer’s solution.

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