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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00163    [Epub ahead of print]
Published online December 14, 2018.
The effect of a mixture of 2.7% sorbitol-0.54% mannitol solution on blood coagulation: an in-vitro, observational healthy-volunteer study using rotational thromboelastometry (ROTEM)
Hyun-Jung Shin, Heijin Lee, Hyo-Seok Na
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
Corresponding author:  Hyo-Seok Na, Tel: +82 31 787 7507, Fax: +82 31 787 4063, 
Email: hsknana@gmail.com
Received: 17 June 2018   • Revised: 9 December 2018   • Accepted: 11 December 2018
Abstract
Background
Irrigation fluid absorption during endoscopic surgery has been known to alter blood coagulation. We investigated the effect of an irrigation fluid on the coagulation according to the hemodilution level using rotational thromboelastometry (ROTEM) tests.
Methods
Venous blood was taken from 12 healthy volunteers and divided into four specimen bottles, which were diluted to different levels (0%, 10%, 20%, and 40%) using a mixture of 2.7% sorbitol–0.54% mannitol solution. Then, ROTEM analysis was performed.
Results
Significant prolongation of clotting time (CT) was observed in the 40% diluted blood sample using both INTEM (P = 0.009) and EXTEM (P = 0.001) assays. However, clot formation time (CFT) was prolonged significantly in the 10%, 20% and 40% diluted blood sample using both INTEM (P < 0.001) and EXTEM (P = 0.002, P < 0.001, and P < 0.001, respectively) assays. Maximum clot firmness (MCF) of INTEM decreased significantly in the 20% (P < 0.001) and 40% (P < 0.001) diluted blood sample. In the MCF of EXTEM and FIBTEM, all of the 10% (P = 0.009 and P = 0.015, respectively), 20% (P = 0.001), and 40% (P < 0.001) dilution showed significant decrease compared with 0% diluted blood sample. Nevertheless, most of the ROTEM values were within reference range except 40% dilution.
Conclusion
Blood became hypocoagulable when it was diluted in vitro with a mixture of 2.7% sorbitol–0.54% mannitol solution. Clot stabilization with fibrin polymerization seemed to be disturbed primarily rather than the initiation of clotting in coagulation pathway.
Key Words: Irrigation fluid; Blood coagulation; Rotational thromboelastometry; Hemodilution
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