1
|
DeBot M, Erickson C, Kelher M, Schaid TR, Moore EE, Sauaia A, Cralley A, LaCroix I, D’Alessandro A, Hansen K, Cohen MJ, Silliman CC, Coleman J. Platelet and cryoprecipitate transfusions from female donors improve coagulopathy in vitro. J Trauma Acute Care Surg 2023; 94:497-503. [PMID: 36728345 PMCID: PMC10038850 DOI: 10.1097/ta.0000000000003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Females are relatively hypercoagulable compared with males, with increased platelet aggregation and improved clot dynamics. However, sex differences in coagulation have not yet been considered in transfusion guidelines. Therefore, our objective was to evaluate hemostatic differences in sex concordant and sex discordant cryoprecipitate and platelet transfusions. We hypothesized that transfusion of blood products from female donors results in improved coagulopathy compared with male blood products. METHODS This was a cohort study evaluating sex dimorphisms in coagulation assays and clotting factors in healthy volunteer plasma and cryoprecipitate. Sex dimorphisms in transfusions were evaluated using an in vitro coagulopathy model. Female or male platelets or single-donor cryoprecipitate was added to "recipient" whole blood after dilution of recipient blood with citrated saline to provoke a coagulopathic profile. Citrated native thromboelastography was then performed. Liquid chromatography/mass spectroscopy was performed on single-donor cryoprecipitate to evaluate sex dimorphisms in the proteome of cryoprecipitate. RESULTS Females have an increased proportion of functional fibrinogen. Transfusion of female-donor platelets and cryoprecipitate induces a larger decrease in R time and greater increase in angle than male-donor platelets or cryoprecipitate. Female-donor cryoprecipitate has increased factor V and factor XIII compared with male cryoprecipitate, and comprehensive proteomics revealed sex differences in several proteins with potential immunological significance. CONCLUSION Platelets and cryoprecipitate from female donors improve coagulopathy more than male blood products in vitro. Increased factor V and factor XIII activity as well as increased fibrinogen activity in female donors appears to drive this disparity. Sex differences in the proteome of cryoprecipitate may influence how transfusions modulate the thromboinflammation of trauma. The differing hemostatic profiles of female and male blood products suggest the potential role of sex-specific transfusions guidelines in hemostatic resuscitation.
Collapse
Affiliation(s)
- Margot DeBot
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Christopher Erickson
- University of Colorado, School of Medicine, Department of Biochemistry and Molecular Genetics, Aurora, CO
| | - Marguerite Kelher
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
- Vitalant Research Institute, Vitalent Mountain Division, Denver, CO
| | - Terry R. Schaid
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Ernest E. Moore
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
- Denver Health Medical Center, Ernest E Moore Shock Trauma Center, Denver, CO
| | - Angela Sauaia
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
- University of Colorado, School of Public Health, Management and Policy, Department of Health Systems, Aurora, CO
| | - Alexis Cralley
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Ian LaCroix
- University of Colorado, School of Medicine, Department of Biochemistry and Molecular Genetics, Aurora, CO
| | - Angelo D’Alessandro
- University of Colorado, School of Medicine, Department of Biochemistry and Molecular Genetics, Aurora, CO
| | - Kirk Hansen
- University of Colorado, School of Medicine, Department of Biochemistry and Molecular Genetics, Aurora, CO
| | - Mitchell J. Cohen
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Christopher C. Silliman
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
- Vitalant Research Institute, Vitalent Mountain Division, Denver, CO
| | - Julia Coleman
- University of Colorado, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| |
Collapse
|
2
|
Blaine KP, Steurer MP. Viscoelastic Monitoring to Guide the Correction of Perioperative Coagulopathy and Massive Transfusion in Patients with Life-Threatening Hemorrhage. Anesthesiol Clin 2018; 37:51-66. [PMID: 30711233 DOI: 10.1016/j.anclin.2018.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The resuscitation of patients with traumatic hemorrhage remains a challenging clinical scenario. The appropriate and aggressive support of the patient's coagulation is of critical importance. Conventional coagulation assays present several shortcomings in this setting. The integration of viscoelastic monitoring in clinical practice has the potential to result in significant improvements. In order to be successful, the provider must understand basics of the methodology, read outs, and the limitations of the technique.
Collapse
Affiliation(s)
- Kevin P Blaine
- Department of Anesthesiology, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, HC4 Suite 3600, Los Angeles, CA 90033, USA; Trauma Anesthesiology Society, Inc, 1001 Fannin St Ste 3700, Houston, TX 77002-6785, USA.
| | - Marc P Steurer
- Trauma Anesthesiology Society, Inc, 1001 Fannin St Ste 3700, Houston, TX 77002-6785, USA; Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF School of Medicine, 1001 Potrero Avenue, Building 5, Room 3C-38, San Francisco, CA 94110, USA
| |
Collapse
|
3
|
Influence of resuscitation fluids, fresh frozen plasma and antifibrinolytics on fibrinolysis in a thrombelastography-based, in-vitro, whole-blood model. Blood Coagul Fibrinolysis 2013; 24:489-97. [PMID: 23406662 DOI: 10.1097/mbc.0b013e32835e4246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hyperfibrinolysis has been identified as a mechanism of trauma coagulopathy associated with poor outcome. The aim of the study was to create a trauma coagulopathy model (TCM) with a hyperfibrinolysis thrombelastography (TEG) pattern similar to injured patients and test the effects of different resuscitation fluids and antifibrinolytics on fibrinolysis. TCM was established from whole blood by either 15% dilution with isotonic saline, lactated Ringer's, Plasma-Lyte, 5% albumin, Voluven, Hextend, 6% dextran in isotonic saline or 30% dilution with lactated Ringer's plus Voluven and supplementation with tissue factor and tissue plasminogen activator (tPA). These combinations resulted in a TCM that could then be 'treated' with tranexamic acid (TXA) or 6-aminocaproic acid (ACA). Clot formation was evaluated by TEG. Whole-blood dilution by 15% with crystalloids and albumin in the presence of tissue factor plus tPA resulted in an abnormal TEG pattern and increased fibrinolysis, as did dilution with synthetic colloids. TXA 1 μg/ml or ACA 10 μg/ml were sufficient to suppress fibrinolysis when TCM was diluted 15% with lactated Ringer's, but 3 μg/ml of TXA or 30 μg/ml of ACA were needed for fibrinolysis inhibition induced by simultaneous euvolemic dilution with lactated Ringer's plus Voluven by 30%. A total of 15% dilution of whole blood in the presence of tissue factor plus tPA results in a hyperfibrinolysis TEG pattern similar to that observed in severely injured patients. Synthetic colloids worsen TEG variables with a further increase of fibrinolysis. Low concentrations of TXA or ACA reversed hyperfibrinolysis, but the efficient concentrations were dependent on the degree of fibrinolysis and whole-blood dilution.
Collapse
|