Journal of Neurosurgical Sciences 2019 May 06

DOI: 10.23736/S0390-5616.19.04679-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Albumin combined with Mannitol impairs whole blood coagulation and platelet function in vitro

Thomas PALMAERS, Julia HINSENKAMP, Elke KRÄMER, Andreas LEFFLER, Markus FLENTJE, Lion SIEG, Hendrik EISMANN ✉

Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany

BACKGROUND: The indication of hydroxyethyl starch is currently under critical discussion and albumin 5% (ALB) has an increasing use in the operating theatre. Therefore, ALB is routinely used in neurosurgical procedures and often combined with mannitol 20% (MAN). Purpose of this in vitro study was to determine the influence of the combination of MAN and ALB on blood coagulation and platelet function.
METHODS: 22 healthy volunteers were included into this study and 21 analysed. Blood was obtained and diluted into five groups: (1) 7% dilution with MAN, (2) 10% dilution with ALB (3) 17% dilution with isotonic balanced electrolyte solution, (4) 17% dilution with MAN + ALB and (5) undiluted blood as control group (CON). Rotational thrombelastometry via ROTEM® (EXTEM, FIBTEM-Test) and thrombocyte aggregometry via Multiplate® (ASPI, ADP and TRAP-test) were used to detect differences within the intervention groups and compared to the control group.
RESULTS: The maximum clot firmness in the FIBTEM test decreased under the normal range with the combination of MAN+ALB: 8mm (5.5-11) compared to CON: 15mm (12.5-20), p<0.05. Platelet function (ADP-test) showed significant decreases for ALB: 51 AUC (40-84) and MAN+ALB: 54 AUC (41-68) compared to CON: 92 AUC (75-101), p<0.05. Except in clotting time all other EXTEM tests of MAN+ALB subgroup showed significant impairment on blood coagulation compared to the control group.
CONCLUSIONS: In this in vitro study clinically relevant dilutions of MAN+ALB showed a significant inhibition of blood coagulation and platelet function. Further in vivo studies are necessary to confirm these results.

KEY WORDS: Mannitol - Albumin - Thrombelastometry - Platelet function - Platelet aggregometry - Coagulation