Effect of progressive haemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation

We have compared the effects of progressive (30% and 60%) in vitrohaemodilution with hydroxyethyl starch (HES), gelatin (GEL) and albumin(ALB) with haemodilution using 0.9% saline in 96 patients bythrombelastography. Haemodilution with HES, GEL and ALB significantly (P< 0.05) compromised coagulation time (k), angle alpha and maximalamplitude (MA), with HES having the most negative effect at 30% and 60%haemodilution (P < 0.05). Haemodilution with saline significantlyaffected all variables of blood coagulation and clot lysis measured bythrombelastography, resulting in an increased coagulability at 30%haemodilution. To specifically assess the intrinsic effect of plasmaexpander molecules on blood coagulation and clot lysis, we analysed thedifference between saline diluted blood (same degree of haemodilution) andplasma expander diluted blood. Prolongation of reaction time (r) was foundfor HES at 30% and 60% haemodilution and for ALB at 60% haemodilution andan increase in clot lysis by HES, GEL and ALB became evident. We concludethat HES, GEL and ALB compromised blood coagulation, while the maximumeffect was found with HES.