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LETTERS TO THE EDITOR

Hemostasis in Patients of Different ABO Blood Groups

Department of Anesthesia, University Hospital, Linköping, Sweden Karolinska Institute, Stockholm, Sweden

To the Editor:

The von Willebrand factor (vWf) operates as a carrier protein for Factor VIII, and mediates platelet adhesion to exposed subendothelium (1). Individuals with the blood group O have smaller plasma concentrations of vWf than those with blood groups A, B, or AB (1). A recent article in Anesthesia & Analgesia addressed the interesting problem of whether the coagulation disturbance from hydroxyethyl starch is more pronounced in patients of the O blood group (2). The authors mentioned the possibility that the decrease in the plasma levels of the VIII/vWf complex might be explained by accelerated elimination after complexing with starch. However, infusion of an isotonic fluid expands the plasma volume, in which the coagulation factors are distributed much more than the corresponding decrease in hematocrit, provided that both changes are expressed as a percentage (3,4). After multiplying the plasma dilution by (1 - hematocrit), it appears to us that all data for VIII:C, vWf antigen, and vWFRCo shown in Table 3 can be explained by dilution, although this does not exclude a more specific action of hydroxyethyl starch on hemostatic mechanisms.

References

1. Rosendaal FR. High levels of factor VIII and venous thrombosis. Thromb Haemost 2000; 83: 1–2.[Medline]
2. Huraux C, Ankri AA, Eyraud D, et al. Hemostatic changes in patients receiving hydroxyethyl starch: the influence of ABO blood group. Anesth Analg 2001; 92: 1396–401.[Abstract/Free Full Text]
3. Flordal PA. The plasma dilution factor: predicting how concentrations in plasma and serum are affected by blood volume variations and blood loss. J Lab Clin Med 1995; 126: 353–7.[Medline]
4. Drobin D, Hahn RG. Volume kinetics of Ringer’s solution in hypovolemic volunteers. Anesthesiology 1999; 90: 81–91.[Web of Science][Medline]

Response

Department of Anesthesiology, Hôpital Pitié-Salpêtrière, Paris, France

In Response:

We appreciate the interest of Dr. Lisander and Dr. Hahn in our study. We agree that dilution is one of the mechanisms for explaining the decrease of the plasma levels of the VIII/vWF complex induced by hydroxyethyl starch infusion. Multiplying the plasma dilution by (1 - hematocrit) does not lead to consistent data regarding the non-O group. However, the major point to be highlighted in this study is that plasma levels in VIII:C, vWf antigen, and vWFRCo are markedly low in the O group comparing with the O group patients after 20 mL hydroxyethyl starch infusion.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Lisander, B. Articles by Huraux, C. Search for Related Content PubMed PubMed Citation Articles by Lisander, B. Articles by Huraux, C.