Annals of Hematology

, 88:255

Citrate artificially masks the haemostatic effect of recombinant factor VIIa in dilutional coagulopathy

  • Christian Fenger-Eriksen
  • Jørgen Ingerslev
  • Else Tønnesen
  • Benny Sørensen
Original Article

DOI: 10.1007/s00277-008-0577-6

Cite this article as:
Fenger-Eriksen, C., Ingerslev, J., Tønnesen, E. et al. Ann Hematol (2009) 88: 255. doi:10.1007/s00277-008-0577-6

Abstract

Most often, thrombelastographic analyses are carried out using citrated blood and re-calcification. However, calcium chelation may affect dynamics of tissue-factor-initiated thrombin generation. The present study investigates the effect of sample anticoagulant on the response of a colloid induced dilutional coagulopathy model to recombinant activated factor VII (rFVIIa) as measured by thrombelastography. Thrombelastographic evaluation of whole blood coagulation activated with minute amounts of tissue factor in a model of in vitro haemodilution with hydroxyethyl starch (HES) 130/0.4 in a prospective laboratory study. Whole blood coagulation was evaluated before and after 30% dilution with HES 130/0.4, and following in vitro addition of rFVIIa to whole blood collected into tubes containing citrate, corn trypsin inhibitor (CTI), and no stabilizers. Haemodilution with HES 130/0.4 induces a coagulopathy characterised by a reduced maximum rate of clot formation and a pronounced reduction in the final clot firmness. With all test mediums investigated, rFVIIa significantly shortened clot initiation phase. In cases of native whole blood and CTI-stabilised whole blood, rFVIIa shortens the clotting time but also demonstrated an acceleration of the maximum velocity of clot formation. When citrate is used as anticoagulants in thrombelastographic clotting assays, these may artificially mask the haemostatic effect of rFVIIa in colloid haemodilution. The effect in vitro of rFVIIa in citrated blood samples may underestimate the haemostatic potential of rFVIIa.

Keywords

Haemodilution Trisodium citrate Corn trypsin inhibitor Plasma substitutes Recombinant activated factor VII Thrombelastography 

Supplementary material

277_2008_577_MOESM1_ESM.pdf (174 kb)
ESM 1(PDF 174 KB)

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Christian Fenger-Eriksen
    • 1
    • 2
  • Jørgen Ingerslev
    • 1
  • Else Tønnesen
    • 2
  • Benny Sørensen
    • 1
  1. 1.Centre for Haemophilia and ThrombosisAarhus University HospitalAarhusDenmark
  2. 2.Department of AnaesthesiologyAarhus University HospitalAarhusDenmark

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