Palmaers T, Hinsenkamp J, Krämer E, Leffler A, Flentje M, Sieg L, Eismann H. Albumin combined with Mannitol impairs whole blood coagulation and platelet function in vitro.
J Neurosurg Sci 2019;
65:634-641. [PMID:
31079437 DOI:
10.23736/s0390-5616.19.04679-4]
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Abstract
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.
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