Hemostasis and Hemodilution: A Quantitative Mathematical Guide for Clinical Practice
Quantitative changes of hemostasis during hemodilution remain unclear. With the increasing popularity of artificial blood substitutes (ABS), which solely provide oxygen-transport capacity, this issue becomes even more complex. We developed a mathematical model to quantitatively analyze hemostasis du...
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| Veröffentlicht in: | Anesthesia and analgesia 2003-04, Vol.96 (4), p.929-935 |
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| creator | Singbartl, Kai Innerhofer, Petra Radvan, Jens Westphalen, Birgit Fries, Dietmar Stögbauer, Raimund Van Aken, Hugo |
| description | Quantitative changes of hemostasis during hemodilution remain unclear. With the increasing popularity of artificial blood substitutes (ABS), which solely provide oxygen-transport capacity, this issue becomes even more complex. We developed a mathematical model to quantitatively analyze hemostasis during hemodilution and validated it by recalculating patient data. We calculated and compared maximal allowable blood losses (MABL) related to minimal acceptable hematocrit, platelet concentration, and plasma fibrinogen concentration. MABL is the maximal blood loss that can be tolerated without any additional blood products. The variable with the smallest MABL thus limits hemodilution foremost. Hemodilution included isovolemic replacement of blood loss with colloid or acute normovolemic hemodilution (ANH) followed by isovolemic replacement of blood loss with colloid and ABS. We also related our findings to preoperative patient data (n = 204). The decline in platelet concentrations rarely ( |
| doi_str_mv | 10.1213/01.ANE.0000052711.68903.5D |
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With the increasing popularity of artificial blood substitutes (ABS), which solely provide oxygen-transport capacity, this issue becomes even more complex. We developed a mathematical model to quantitatively analyze hemostasis during hemodilution and validated it by recalculating patient data. We calculated and compared maximal allowable blood losses (MABL) related to minimal acceptable hematocrit, platelet concentration, and plasma fibrinogen concentration. MABL is the maximal blood loss that can be tolerated without any additional blood products. The variable with the smallest MABL thus limits hemodilution foremost. Hemodilution included isovolemic replacement of blood loss with colloid or acute normovolemic hemodilution (ANH) followed by isovolemic replacement of blood loss with colloid and ABS. We also related our findings to preoperative patient data (n = 204). The decline in platelet concentrations rarely (<2% of all patients) limits hemodilution. By contrast, critical plasma fibrinogen (≤100 mg/dL) concentrations can often (≤20% of all patients) limit hemodilution if their initial concentrations are within the lower normal range (<300 mg/dL). These findings become more frequent if ANH is combined with ABS. Under those circumstances ANH blood products are solely required for stabilization of hemostasis, thereby defeating the original purpose of combining ANH with ABS.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1213/01.ANE.0000052711.68903.5D</identifier><identifier>PMID: 12651636</identifier><identifier>CODEN: AACRAT</identifier><language>eng</language><publisher>Hagerstown, MD: International Anesthesia Research Society</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood Loss, Surgical - physiopathology ; Blood Substitutes - administration & dosage ; Blood Substitutes - therapeutic use ; Blood Volume - physiology ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Erythrocyte Count ; Fibrinogen - analysis ; Hematocrit ; Hemodilution - statistics & numerical data ; Hemostasis - physiology ; Humans ; Intraoperative Period ; Medical sciences ; Models, Statistical ; Platelet Count ; Prospective Studies ; Reproducibility of Results ; Transfusions. Complications. Transfusion reactions. 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With the increasing popularity of artificial blood substitutes (ABS), which solely provide oxygen-transport capacity, this issue becomes even more complex. We developed a mathematical model to quantitatively analyze hemostasis during hemodilution and validated it by recalculating patient data. We calculated and compared maximal allowable blood losses (MABL) related to minimal acceptable hematocrit, platelet concentration, and plasma fibrinogen concentration. MABL is the maximal blood loss that can be tolerated without any additional blood products. The variable with the smallest MABL thus limits hemodilution foremost. Hemodilution included isovolemic replacement of blood loss with colloid or acute normovolemic hemodilution (ANH) followed by isovolemic replacement of blood loss with colloid and ABS. We also related our findings to preoperative patient data (n = 204). The decline in platelet concentrations rarely (<2% of all patients) limits hemodilution. By contrast, critical plasma fibrinogen (≤100 mg/dL) concentrations can often (≤20% of all patients) limit hemodilution if their initial concentrations are within the lower normal range (<300 mg/dL). These findings become more frequent if ANH is combined with ABS. Under those circumstances ANH blood products are solely required for stabilization of hemostasis, thereby defeating the original purpose of combining ANH with ABS.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood Loss, Surgical - physiopathology</subject><subject>Blood Substitutes - administration & dosage</subject><subject>Blood Substitutes - therapeutic use</subject><subject>Blood Volume - physiology</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Erythrocyte Count</subject><subject>Fibrinogen - analysis</subject><subject>Hematocrit</subject><subject>Hemodilution - statistics & numerical data</subject><subject>Hemostasis - physiology</subject><subject>Humans</subject><subject>Intraoperative Period</subject><subject>Medical sciences</subject><subject>Models, Statistical</subject><subject>Platelet Count</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Transfusions. Complications. Transfusion reactions. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Loss, Surgical - physiopathology</topic><topic>Blood Substitutes - administration & dosage</topic><topic>Blood Substitutes - therapeutic use</topic><topic>Blood Volume - physiology</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Erythrocyte Count</topic><topic>Fibrinogen - analysis</topic><topic>Hematocrit</topic><topic>Hemodilution - statistics & numerical data</topic><topic>Hemostasis - physiology</topic><topic>Humans</topic><topic>Intraoperative Period</topic><topic>Medical sciences</topic><topic>Models, Statistical</topic><topic>Platelet Count</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Singbartl, Kai</creatorcontrib><creatorcontrib>Innerhofer, Petra</creatorcontrib><creatorcontrib>Radvan, Jens</creatorcontrib><creatorcontrib>Westphalen, Birgit</creatorcontrib><creatorcontrib>Fries, Dietmar</creatorcontrib><creatorcontrib>Stögbauer, Raimund</creatorcontrib><creatorcontrib>Van Aken, Hugo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Singbartl, Kai</au><au>Innerhofer, Petra</au><au>Radvan, Jens</au><au>Westphalen, Birgit</au><au>Fries, Dietmar</au><au>Stögbauer, Raimund</au><au>Van Aken, Hugo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemostasis and Hemodilution: A Quantitative Mathematical Guide for Clinical Practice</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2003-04-01</date><risdate>2003</risdate><volume>96</volume><issue>4</issue><spage>929</spage><epage>935</epage><pages>929-935</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><coden>AACRAT</coden><abstract>Quantitative changes of hemostasis during hemodilution remain unclear. With the increasing popularity of artificial blood substitutes (ABS), which solely provide oxygen-transport capacity, this issue becomes even more complex. We developed a mathematical model to quantitatively analyze hemostasis during hemodilution and validated it by recalculating patient data. We calculated and compared maximal allowable blood losses (MABL) related to minimal acceptable hematocrit, platelet concentration, and plasma fibrinogen concentration. MABL is the maximal blood loss that can be tolerated without any additional blood products. The variable with the smallest MABL thus limits hemodilution foremost. Hemodilution included isovolemic replacement of blood loss with colloid or acute normovolemic hemodilution (ANH) followed by isovolemic replacement of blood loss with colloid and ABS. We also related our findings to preoperative patient data (n = 204). The decline in platelet concentrations rarely (<2% of all patients) limits hemodilution. By contrast, critical plasma fibrinogen (≤100 mg/dL) concentrations can often (≤20% of all patients) limit hemodilution if their initial concentrations are within the lower normal range (<300 mg/dL). These findings become more frequent if ANH is combined with ABS. Under those circumstances ANH blood products are solely required for stabilization of hemostasis, thereby defeating the original purpose of combining ANH with ABS.</abstract><cop>Hagerstown, MD</cop><pub>International Anesthesia Research Society</pub><pmid>12651636</pmid><doi>10.1213/01.ANE.0000052711.68903.5D</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Loss, Surgical - physiopathology Blood Substitutes - administration & dosage Blood Substitutes - therapeutic use Blood Volume - physiology Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Erythrocyte Count Fibrinogen - analysis Hematocrit Hemodilution - statistics & numerical data Hemostasis - physiology Humans Intraoperative Period Medical sciences Models, Statistical Platelet Count Prospective Studies Reproducibility of Results Transfusions. Complications. Transfusion reactions. Cell and gene therapy |
| title | Hemostasis and Hemodilution: A Quantitative Mathematical Guide for Clinical Practice |
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