Background: ¬Current prehospital haemostatic resuscitation is largely based on platelet-poor blood components, e.g. red cells and plasma (RCP). Clinical trials have demonstrated improved outcomes compared to crystalloid resuscitation but the effect of these components and whole blood (WB) on trauma-induced coagulopathy (TIC) have not been fully characterised.

Aims: Compare the ability of WB versus RCP to correct ex vivo platelet-related haemostatic parameters in patients with TIC.

Methods: Samples were collected from trauma patients who activated the major haemorrhage protocol prehospital and were enrolled into a prospective cohort study (ISRCTN12962642) at a UK major trauma center in 2021/2022. Each sample was aliquoted and spiked ex vivo with a volume of RCP or WB equivalent to four units. ROTEM EXTEM and FIBTEM were performed on non-spiked and spiked samples. Platelet count was measured using flow cytometry, while aggregation and agglutination with multiple electrode aggregometry. The original components and healthy-donor samples were assayed as controls (REC 07/Q702/24). RCP and WB were stored at 4°C up to two weeks.

Results: Samples from 19 adult trauma patients and 5 healthy donors were analysed. Patients’ median age was 31 years, 89% were male, TIC was present in 68% (EXTEM A5

Conclusion(s): When compared to RCP ex vivo, WB preserves or improves most platelet-related haemostatic parameters.

Image 1

Figure 1. Impact of RCP and WB spiking on overall clot strength -A-, correction of coagulopathy -B-, platelet-related clot strength -C- and platelet dysfunction -D-. Box-whisker plots are plotted according to Tukey’s method. Dotted lines represent previously identified cut-off for coagulopathy -EXTEM A5 <=40mm- and platelet dysfunction -EXTEM – FIBTEM A5 <=30mm-. Statistical comparisons performed with paired Wilcoxon signed-rank tests. Bonferroni correction was applied to three comparisons. HD, healthy donors; RCP, red cells and plasma; WB, whole blood; EXTEM, tissue factor-activated rotational thromboelastometry; FIBTEM, tissue factor-activated rotational thromboelastometry plus cytochalasin D; A5, clot amplitude/strength at 5 minutes.

Image 2

Figure 2. Impact of RCP and WB spiking on other key EXTEM parameters and platelet count, aggregation and agglutination. Normalisation was performed by subtracting the mean and dividing by the standard deviation of each parameter. The medians and interquartile range of the difference between the RCP-spiked samples or the WB-spiked ones and the original samples were then calculated and plotted. Statistical comparisons performed with paired Wilcoxon signed-rank tests. A negative delta for EXTEM CT, EXTEM CFT and EXTEM ML, and a positive one for the remaining variables is indicative of a pro-haemostatic correction. RCP, red cells and plasma; WB, whole blood; EXTEM, tissue factor-activated rotational thromboelastometry; CT, clot time; CFT, clot formation time; AUC, area under the first derivative curve; ML, maximum lysis; PLT, platelets; MEA, multiple electrode aggregometry; ADP, aggregation triggered by adenosine diphosphate -6.5M-; COL, aggregation triggered by collagen -3.2μg/mL-, TRAP, aggregation triggered by thrombin receptor activator peptide 6 -32M-; ASPI, aggregation triggered by arachidonic acid -0.5mM-; RISTO, agglutination triggered by ristocetin -0.77mg/mL-.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/whole-blood-better-supports-platelet-measures-of-haemostasis-compared-to-red-cells-and-plasma-an-ex-vivo-spiking-study/