British Journal of Anaesthesia, Vol 80, Issue 5 612-616, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
T. G. Ruttmann, MFM. James and I. Aronson
We have investigated the effects of haemodilution with either saline or
hydroxyethyl starch (200/0.5) (HES) on blood coagulation in healthy
volunteers in vivo. Standard haematological tests (packed cell volume
(PCV), platelets, prothrombin time (PT), activated partial thromboplastin
time (aPTT), fibrinogen, antithrombin III, bleeding time and platelet
aggregation), and thrombelastography (TEG) were performed before and after
administration of either 0.9% saline 1000 ml or HES 1000 ml i.v. over a
30-min period. Dilution of PCV and platelet concentrations as a result of
volume load were 9% in the saline group and 19% in the HES group.
Reductions in fibrinogen (18.6% and 28.8%) and antithrombin III (25.5% and
37.8%) were significantly greater than could be explained by haemodilution
alone in both groups. Indices of platelet aggregation were significantly
enhanced by saline haemodilution, but not by HES, which inhibited
epinephrine-induced aggregation and prolonged bleeding time. TEG in the
saline group showed significantly shortened r and k times (24% and 26%,
respectively), and increased alpha angle (24%) and maximum amplitude (MA,
6%). HES haemodilution decreased MA (11%) but did not affect other TEG
variables. We conclude that haemodilution of normal blood exerted a
procoagulant effect, possibly by enhancement of thrombin formation.
Circulating concentrations of antithrombin III were depleted more than
could be explained by haemodilution alone, leading to a hypercoagulable
state. This effect was offset by an antiplatelet action of HES, which was
not seen with saline. The mechanism is unknown.
CLINICAL INVESTIGATIONS
In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation
Department of Anaesthesia, University of Cape Town, South Africa; Department of Haematology, University of Cape Town, South Africa
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