Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000400003
Brazilian Journal of Anesthesiology
Artigo Científico

Efeito da hemodiluição normovolêmica aguda na coagulação sanguínea: comparação entre os testes colhidos de um modelo in vivo e de um modelo in vitro

Effects of acute normovolemic hemodilution on blood coagulation: comparison between tests of an in vivo and an in vitro model

Marco Aurélio Beloto de Souza; Jyrson Guilherme Klamt; Luís Vicente Garcia

http://dx.doi.org/10.1590/S0034-70942010000400003 Braz J Anesthesiol, vol.60, n4, p.369-375, 2010
PDF Português
PDF English
Downloads: 1
Views: 1073

Resumo

JUSTIFICATIVA E OBJETIVOS: A hemodiluição normovolêmica produz resultados conflitantes na hemostasia, pois os trabalhos diferem quanto a tipo de líquido utilizado, profundidade da hemodiluição, método utilizado para avaliar a hemostasia e forma de se produzir hemodiluição. O efeito da hemodiluição na hemostasia pode depender da forma como ela é feita, se no modelo in vivo ou no modelo in vitro. O objetivo deste estudo foi avaliar e comparar a hemostasia em ambos os modelos, em dois diferentes graus de profundidade. MÉTODO: Treze pacientes foram submetidos à hemodiluição normovolêmica aguda e o hematócrito foi reduzido para 30% e 20%. A volemia foi mantida com lactato de Ringer. Foram colhidas amostras de sangue para avaliação da hemostasia nos momentos M1 antes da hemodiluição, M2 20 minutos após a obtenção do hematócrito de 30% e M3 20 minutos após a obtenção do hematócrito de 20%. Antes da hemodiluição, amostras de sangue foram colhidas para a realização da hemodiluição em um tubo de ensaio. Os graus de hemodiluição no tubo de ensaio (in vitro) foram os mesmos que os produzidos nos pacientes (in vivo). A hemostasia foi avaliada por meio dos tempos de protrombina, tromboplastina parcial ativado e de trombina e da quantificação do fibrinogênio. RESULTADOS: O comportamento dos testes que avaliaram a hemostasia foi idêntico nos dois modelos utilizados. Houve aumento do TP, do TTPA e do TT e diminuição da concentração de fibrinogênio. Quanto maior o grau de hemodiluição, maior o comprometimento da coagulação. CONCLUSÕES: O modelo in vitro pode substituir o modelo in vivo na avaliação da hemostasia durante hemodiluição normovolêmica aguda.

Palavras-chave

SANGUE, hemodiluição normovolêmica

Abstract

BACKGROUND AND OBJECTIVES: Normovolemic hemodilution produces conflicting results on hemostasis, since works differ according to the fluids used, degree of hemodilution, method used to evaluate hemostasis, and the way used to produce hemodilution. The effects of hemodilution on hemostasis can depend on how it is done and whether an in vivo or an in vitro model is used. The objective of this study was to evaluate and compare hemostasis in two different degrees of hemodilution in both models. METHODS: Thirteen patients underwent acute normovolemic hemodilution with a reduction in hematocrit to 30% and 20%. Volemia was maintained with Ringer's lactate. Blood samples for evaluation of hemostasis were collected at moments M1 before hemodilution, M2 20 minutes after obtaining a hematocrit of 30%, and M3 20 minutes after obtaining a hematocrit of 20%. Before hemodilution, blood samples were collected to perform hemodilution in a test tube. The degree of hemodilution in the test tube (in vitro) was the same as that produced in the patients (in vivo). Hemostasis was evaluated by the prothrombin time, partial activated thromboplastin time, and thrombin time, and by quantifying fibrinogen. RESULTS: The behavior of the tests that evaluated hemostasis was identical in both models. An increase in PT, aPTT, and TT, as well as a reduction in the concentration of fibrinogen was observed. The higher degree of hemodilution was associated with greater compromise of coagulation. CONCLUSIONS: The in vitro model can substitute the in vivo mode in the evaluation of hemostasis during acute normovolemic hemodilution.

Keywords

BLOOD, normovolemic hemodilution

Referências

Bryson GL, Laupacis A, Wells GA. Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion?: A meta-analysis. Anesth Analg. 1998;86:9-15.

Goodnough LT. Acute normovolemic hemodilution. Vox Sanguinis. 2002;83(^s1):211-215.

Crystal GJ, Salem MR. Hemodynamic compensation during acute normovolemic hemodilution. Anesthesiology. 2004;100.

Singbartl K, Innerhofer P, Radvan J. Hemostasis and hemodilution: a quantitative mathematical guide for clinical practice. Anesth Analg. 2003;96:929-935.

Petroianu GA, Liu J, Maleck WH. The effect of in vitro hemodilution with gelatin, dextran, hydroxyethyl starch, or Ringer's solution on thrombelastograph. Anesth Analg. 2000;90:795-800.

Ruttmann TG, James MFM. Aronson I: In vivo investigation into the effects haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation. Br J Anaesth. 1998;80:612-616.

Jones SB, Whitten CW, Despotis GJ. The influence of crystalloid and colloid replacement solutions in acute normovolemic hemodiluton: a preliminary survey of hemostatic markers. Anesth Analg. 2003;96:363-68.

McLoughlin TMJ, Fontana JL, Alving B. Profound normovolemic hemodilution: hemostatic effects in patients and in a porcine model. Anesth Analg. 1996;83:459-465.

Konrad C, Markl T, Schuepfer G. The effects of in vitro hemodilution with gelatin, hydroxietyl starch, and lactated Ringer's solution on markers of coagulation: an analysis using SONOCLOT. Anesth Analg. 1999;88:483-488.

Roche AM, James MFM, Grocott MPW. Citrate blood does not reliably reflect fresh whole blood coagulability in trials of in vitro hemodilution. Anesth Analg. 2003;96:58-61.

Egli GA, Zollinger A, Seifert B. Effect of progressive haemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation. Br J Anaesth. 1997;78:684-689.

Brazil EV, Coats TJ. Sonoclot coagulation analysis of in vitro haemodilution with resuscitation solutions. J R Soc Med. 2000;93:507-510.

Fries D, Innerhofer P, Klingler A. The effect of the combined administration of colloids and lactated Ringer´s solution on the coagulation system: an in vitro study using thrombelastograph coagulation analysis (ROTEG). Anesth Analg. ;94:1280-1287.

Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58:277-280.

Nelson CL, Fontenot HJ, Flahiff C. An algorithm to optimize perioperative blood management in surgery. Clin Orthop. 1998;357:36-42.

Brecher ME, Rosenfeld M. Mathematical and computer modeling of acute normovolemic hemodilution. Transfusion. 1994;34:176-179.

Vara-Thorbek R, Guerrero-Fernandez Marcote JA. Hemodynamic response of elderly patients undergoing major surgery under moderate normovolemic hemodilution. Eur Surg Res. 1985;17:372-376.

Boldt J, Haisch G, Suttner G. Are lactated Ringer´s solution and normal saline solution equal with regard to coagulation?. Anesth Analg. 2002;94:378-384.

Ng KFJ, Lam CCK, Chan LC. In vivo effect of haemodilution with saline on coagulation: a randomized controlled trial. Br J Anaesth. 2002;88:475-480.

Ruttmann TG, James MF, Lombard EM. Haemodilution-induced enhancement of coagulation is attenuated in vitro by restoring antithrombin III to pre-dilution concentrations. Anaesth Intensive Care. 2001;29:489-493.

Ruttmann TG, James MF, Viljoen JF. Haemodilution induces a hypercoagulable state. Br J Anaesth. 1996;76:412-414.

Ruttmann TG, James MF. Pro-coagulant effect of in vitro haemodilution is not inhibited by aspirin. Br J Anaesth. 1999;83:330-332.

Ruttmann TG, Lemmens HJ, Mallott KA. The haemodilution enhanced onset of coagulation as measured by the tromboelastogram is transient. Eur J Anaesthesiol. 2006;23:574-579.

Gorton H, Lyons G, Manraj P. Preparation for regional anaesthesia induces changes in thrombelastography. Br J Anaesth. 2000;84:403-404.

Roche AM, James MFM, Grocott MPW. Citrate blood does not reliably reflect fresh whole blood coagulability in trials of in vitro hemodilution. Anesth Analg. 2003;96:58-61.

Iselin MB, Willimann PFX, Seifert B. Isolated reduction of haematocrit does not com promise in vitro blood coagulation. Br J Anaesth. 2001;87:246-249.

Dirkmann D, Hanke AA, Görlinger K. Hipothermia and acidosis synergistically impair coagulation in human whole blood. Anesth Analg. 2008;106:1627-1632.

Shaz BH, Dente CJ, Harris RS. Transfusion management of trauma patients. Anesth Analg. 2009;108:1760-1768.

Moor P, Woolley T, Midwinter M. Coagulation tests in future studies: what to use?. Br J Anaesth. 2009;102.

Horlocker TT, Nuttall GA, Dekutoski MB. The accuracy of coagulation tests during spinal fusion and instrumentation. Anesth Analg. 2001;93:33-38.

Lourenço DM. Avaliação Laboratorial da Hemostasia. Hematologia: Fundamentos e Prática. 2001:752-754.

5dceb53b0e8825017fbf58f3 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections