• Anna Agren, Gustaf Edgren, Malin Kardell, Anders Ostlund, and Agneta Taune Wikman.
• Department of Medicine, Division of Haematology, Coagulation Unit, Karolinska University Hospital, Stockholm, Sweden Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
• Blood Transfus Italy. 2014 Oct 1;12(4):491-6.

BackgroundThromboelastography is increasingly used to evaluate coagulation in massively bleeding patients. The aim of this study was to investigate how different combinations of blood components affect in vitro whole blood clotting measured by thromboelastography.Materials And MethodsPacked red blood cells, plasma and platelets from fresh and old blood components were mixed in vitro, in proportions of 4:4:1, 5:5:2, 8:4:1 and 2:1:0, and analysed with thromboelastography. For the ratio 4:4:1 the experiment was done at both 37 °C and 32 °C.ResultsThromboelastography curves were within normal reference values for the blood component proportions of 4:4:1 and 5:5:2. For 8:4:1, the angle and maximal amplitude were reduced below normal values, indicating low levels of fibrinogen and/or platelets. For the 2:1:0 proportion, all parameters were affected resulting in severely impaired in vitro clot formation. The reaction-time, reflecting the coagulation factor-dependent, initial clot formation, was slightly increased at a low temperature. Prolonged storage of the components did not affect the curve.DiscussionWith the introduction of guidelines on the management of massive bleeding it is important to have tools for the assessment of the new protocols. In vitro evaluation of mixtures of packed red blood cells, plasma and platelets by thromboelastography may be relevant in the prediction of in vivo clot formation and haemostasis.

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