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Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters
Intraoperative fluid therapy is regularly used in patients undergoing cardiac surgery procedures with cardiopulmonary bypass (CPB). Although fluid administration has several advantages, it unavoidably leads to hemodilution. The hemodilution may further influence the interpretation of concentration-b...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10417005/ https://www.ncbi.nlm.nih.gov/pubmed/37568959 http://dx.doi.org/10.3390/diagnostics13152596 |
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author | Innerhofer, Nicole Rajsic, Sasa Ronzani, Marco Breitkopf, Robert Gollmann Tepeköylü, Can Velik-Salchner, Corinna Schlosser, Lisa Fries, Dietmar Streif, Werner Schirmer, Michael Martini, Judith |
author_facet | Innerhofer, Nicole Rajsic, Sasa Ronzani, Marco Breitkopf, Robert Gollmann Tepeköylü, Can Velik-Salchner, Corinna Schlosser, Lisa Fries, Dietmar Streif, Werner Schirmer, Michael Martini, Judith |
author_sort | Innerhofer, Nicole |
collection | PubMed |
description | Intraoperative fluid therapy is regularly used in patients undergoing cardiac surgery procedures with cardiopulmonary bypass (CPB). Although fluid administration has several advantages, it unavoidably leads to hemodilution. The hemodilution may further influence the interpretation of concentration-based laboratory parameters like hemoglobin (Hgb), platelet count (PLT) or prothrombin time (PT). These all parameters are commonly used to guide blood product substitution. To assess the impact of dilution on these values, we performed a prospective observational study in 174 patients undergoing elective cardiac surgery. We calculated the total blood volume according to Nadler’s formula, and fluid therapy was correlated with a newly developed dilution coefficient formula at the end of CPB. Intravenously applied fluids were measured from the beginning of the anesthesia (baseline, T(0)) and 15 min after the end of protamine infusion (end of CPB, T(1)). The amount of the administered volume (crystalloids or colloids) was calculated according to the percentage of the intravascular fluid effect, and intraoperative diuresis was further subtracted. The median blood volume increased by 148% in all patients at T(1) compared to the calculated total blood volume at T(0). This led to a dilution-dependent decrease of 38% in all three parameters (Hgb 24%, corrCoeff = 0.53; PLT 41%, corrCoeff = 0.68; PT 44%, corrCoeff = 0.54). The dilution-correlated decrease was significant for all parameters (p < 0.001), and the effect was independent from the duration of CPB. We conclude that the presented calculation-based approach could provide important information regarding actual laboratory parameters and may help in the guidance of the blood product substitution and potential transfusion thresholds. Further research on the impact of dilution and related decision-making for blood product substitution, including its impact on morbidity and mortality, is warranted. |
format | Online Article Text |
id | pubmed-10417005 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104170052023-08-12 Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters Innerhofer, Nicole Rajsic, Sasa Ronzani, Marco Breitkopf, Robert Gollmann Tepeköylü, Can Velik-Salchner, Corinna Schlosser, Lisa Fries, Dietmar Streif, Werner Schirmer, Michael Martini, Judith Diagnostics (Basel) Article Intraoperative fluid therapy is regularly used in patients undergoing cardiac surgery procedures with cardiopulmonary bypass (CPB). Although fluid administration has several advantages, it unavoidably leads to hemodilution. The hemodilution may further influence the interpretation of concentration-based laboratory parameters like hemoglobin (Hgb), platelet count (PLT) or prothrombin time (PT). These all parameters are commonly used to guide blood product substitution. To assess the impact of dilution on these values, we performed a prospective observational study in 174 patients undergoing elective cardiac surgery. We calculated the total blood volume according to Nadler’s formula, and fluid therapy was correlated with a newly developed dilution coefficient formula at the end of CPB. Intravenously applied fluids were measured from the beginning of the anesthesia (baseline, T(0)) and 15 min after the end of protamine infusion (end of CPB, T(1)). The amount of the administered volume (crystalloids or colloids) was calculated according to the percentage of the intravascular fluid effect, and intraoperative diuresis was further subtracted. The median blood volume increased by 148% in all patients at T(1) compared to the calculated total blood volume at T(0). This led to a dilution-dependent decrease of 38% in all three parameters (Hgb 24%, corrCoeff = 0.53; PLT 41%, corrCoeff = 0.68; PT 44%, corrCoeff = 0.54). The dilution-correlated decrease was significant for all parameters (p < 0.001), and the effect was independent from the duration of CPB. We conclude that the presented calculation-based approach could provide important information regarding actual laboratory parameters and may help in the guidance of the blood product substitution and potential transfusion thresholds. Further research on the impact of dilution and related decision-making for blood product substitution, including its impact on morbidity and mortality, is warranted. MDPI 2023-08-04 /pmc/articles/PMC10417005/ /pubmed/37568959 http://dx.doi.org/10.3390/diagnostics13152596 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Innerhofer, Nicole Rajsic, Sasa Ronzani, Marco Breitkopf, Robert Gollmann Tepeköylü, Can Velik-Salchner, Corinna Schlosser, Lisa Fries, Dietmar Streif, Werner Schirmer, Michael Martini, Judith Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters |
title | Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters |
title_full | Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters |
title_fullStr | Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters |
title_full_unstemmed | Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters |
title_short | Loss or Dilution—A New Diagnostic Method to Assess the Impact of Dilution on Standard Laboratory Parameters |
title_sort | loss or dilution—a new diagnostic method to assess the impact of dilution on standard laboratory parameters |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10417005/ https://www.ncbi.nlm.nih.gov/pubmed/37568959 http://dx.doi.org/10.3390/diagnostics13152596 |
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