Abstract Number: PB0391
Meeting: ISTH 2020 Congress
Theme: Coagulation and Natural Anticoagulants » Regulation of Coagulation
Background: Trauma is associated with coagulopathy explained on the basis of acidosis concurrently observed, due to findings of coagulation inhibition by dilute acids in in vitro studies. However, these studies have not taken into account the concentration and type of acids that have not been systematically investigated.
Aims: To compare the effects of HCL, lactic acid and sulphuric acids different acids at concentration ranges 0.1 M to 1.0 M on whole blood coagulation using Thromboelastography in vitro.
Methods: After ethical approval, blood was obtained from healthy human volunteers in citrate tubes and mixed in a ratio of 1:5 with HCL, sulfuric and lactic acids at concentration at 0.2 M. Thereafter, 320 µL of whole blood was added to 20 µL of calcium chloride in thromboelastography cups. Next coagulation effects were tested at concentration ranges of 0.1 M to 1.0 M. Tests were allowed to run for 60 minutes.
Results: In 0.2 M lactic acid TEG parameters were closer to control undiluted samples suggesting that it preserves coagulation (fig 1). However, with increase in acid concentration there was progressive inhibition of blood clotting in all the three acids. TEG flat trace in 0.3-0.4 M HCL, 0.3-0.6 M in lactic acid and only 0.2 M in Sulphuric acid. Paradoxically, coagulation started increasing in 0.3 M sulfuric acid, 0.5 M HCL, and 1.0 m in lactic acid. In 1.0 M HCL and sulphuric acid were hypercoagulable (Table 1). Surprisingly, significant lysis was observed in 0.2 M lactic acid, and sulphuric acid 0.3-1.0 M with concurrent diamond fibrinolytic pattern.
Conclusions: It appears that whole blood coagulation outcome is dependent on type of acid and particular concentration. Increase in acid concentration progressively inhibit coagulation most marked around 0.2-0.4 M. The study illustrates that acidic anions modulate coagulation independent of proton suggesting interaction with coagulation factors.
TEG parameters | Acid | Neat (control) N=7 | 0.1 M (N=7) | 0.2 M (N=7) | 0.3 M (N=7) | 0.4 M (N=7) | 0.5 M (N=7) | 0.6 M (N=7) | 1.0 M (N=2) |
R (mm) | HCL Lactic acid H2SO4 | 14.36 12.70 14.69 | 14.01 11.90 61.2 | 37.64 31.10 ∞ | ∞ ∞ 4.029 | ∞ ∞ 2.729 | 24.67 ∞ 1.771 | 15.91 ∞ 1.243 | 2.829 22.95 0.9571 |
K (mm) | HCL Lactic acid H2SO4 | 6.786 4.700 6.314 | 5.057 4.100 8.557 | 16.16 8.500 ∞ | ∞ ∞ 2.643 | ∞ ∞ 1.171 | 10.97 ∞ 1.1 | 14.43 ∞ 1.343 | 4.85 25.00 1.5 |
alpha (degrees) | HCL Lactic acid H2SO4 | 33.91 38.70 31.47 | 36.59 41.30 1.557 | 10.34 11.00 0 | 0 0.0 57.91 0 | 0 0.0 73.87 | 4.843 0.0 74.76 | 16.71 0.0 76.54 | 41.95 6.700 77.1 |
Ma (mm) | HCL Lactic acid H2SO4 | 44.86 48.00 42.84 | 45.31 50.80 8.343 | 31.89 26.30 0 | 0 0.0 81.76 | 0 0.0 81.17 | 16.79 0.0 86.46 | 55.26 0.0 85.17 | 73 42.35 83.3 |
Lysis at 30 minutes(%) | HCL Lactic acid H2SO4 | 1.243 1.371 1.4 | 0.5286 0.2857 0.5143 | 0 13.90 0 | 0 0.0 50.34 | 0 0.0 9.329 | 1.429 0.0 52.86 | 0.4143 0.0 41.3 | 0 0.0 88.35 |
[Table.1 Mean Thromboelastography parameters in different acids at different concentrations]
[Figure 1Mean TEG parameters in whole blood mixed with 0.2 M of different acids]
To cite this abstract in AMA style:
Ogweno G, Chege B, Waweru P. The Effects of Acids on Whole Blood Coagulation is Depended on the Type of Acid and Concentration as Assessed by Thromboelastography (TEG) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-effects-of-acids-on-whole-blood-coagulation-is-depended-on-the-type-of-acid-and-concentration-as-assessed-by-thromboelastography-teg/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-effects-of-acids-on-whole-blood-coagulation-is-depended-on-the-type-of-acid-and-concentration-as-assessed-by-thromboelastography-teg/