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Introduction <p>Correction of a prolonged CK-TEG R-time requires the administration of fresh frozen plasma (FFP). However, the relationship between the volume required to normalize the R-time and the patient’s plasma volume (PV<sub>i</sub>) has not been investigated. This study investigated the impact of the PV<sub>i</sub> on the amount of FFP needed to normalize the R-time.</p> Methods <p>30 patients receiving FFP to normalize their R-times were analyzed from the standpoint of sex distribution and R-time response to the administration of FFP. PV<sub>i</sub> was calculated as blood volume minus hematocrit (Hct). Data included age, sex, height, weight, Hct, changes in PV<sub>i</sub> (ΔPV) and ΔR-time within 24&#xa0;h of administration of FFP. Responders were divided in high and low based on a decrease in R-time &gt; 5&#xa0;min after the administration of FFP. Data presented as mean ± SD and median with interquartile range were analyzed with parametric and non-parametric tests as applicable.</p> Results <p>Females had a smaller PV<sub>i</sub> (2.6 ± 0.4 vs. 3.7 ± 0.6; p &lt; 0.05), yielding a larger ΔPV (14.0 ± 7.0% vs. 10.6 ± 5.4% from 353 ± 141 vs. 381 ± 174&#xa0;ml of FFP, respectively; p &gt; 0.05). They required less FFP for a ΔR-time of one minute (80 ± 59 vs. 116 ± 64&#xa0;ml; p &gt; 0.05). There was a significant difference in the number of high responders between females and males (7/11 vs. 5/19; p &lt; 0.05). The R-time response did not differ with respect to age, and the PV<sub>i</sub> before transfusions but it was affected by the amount FFP and the resulting ΔPV (483 ± 173 vs. 296 ± 99 and 17.0% ± 6.6% vs. 8.6% ± 3.0%; p &lt; 0.05).</p> Conclusions <p>We conclude that: 1) The amount of FFP required to normalize the R-time is lower than the recommended dose of 10–20&#xa0;ml/kg: 2) 6.8&#xa0;ml/kg of FFP, corresponding to an initial administration of two units of FFP (~ 500&#xa0;ml) will provide an increase of 15.6% in the concentration of coagulation factors sufficient to normalize the R-time: 3) The assessment of PV<sub>i</sub> is the key element required to estimate the volume of FFP needed to correct a prolonged R-time.</p>

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The impact of the patient’s plasma volume on the amount of fresh frozen plasma needed to normalize the thromboelastographic reaction time

  • 期刊论文

  • 发表日期：

    2025年5月2日

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  • Mordechai Caplan,
  • Natalia Torres-Acevedo,
  • Patrizio Petrone,
  • Lindsay Beach,
  • Reddy H. Srinivas,
  • Anna Liveris,
  • Corrado P. Marini,
  • John McNelis

摘要

Introduction

Correction of a prolonged CK-TEG R-time requires the administration of fresh frozen plasma (FFP). However, the relationship between the volume required to normalize the R-time and the patient’s plasma volume (PVi) has not been investigated. This study investigated the impact of the PVi on the amount of FFP needed to normalize the R-time.

Methods

30 patients receiving FFP to normalize their R-times were analyzed from the standpoint of sex distribution and R-time response to the administration of FFP. PVi was calculated as blood volume minus hematocrit (Hct). Data included age, sex, height, weight, Hct, changes in PVi (ΔPV) and ΔR-time within 24 h of administration of FFP. Responders were divided in high and low based on a decrease in R-time > 5 min after the administration of FFP. Data presented as mean ± SD and median with interquartile range were analyzed with parametric and non-parametric tests as applicable.

Results

Females had a smaller PVi (2.6 ± 0.4 vs. 3.7 ± 0.6; p < 0.05), yielding a larger ΔPV (14.0 ± 7.0% vs. 10.6 ± 5.4% from 353 ± 141 vs. 381 ± 174 ml of FFP, respectively; p > 0.05). They required less FFP for a ΔR-time of one minute (80 ± 59 vs. 116 ± 64 ml; p > 0.05). There was a significant difference in the number of high responders between females and males (7/11 vs. 5/19; p < 0.05). The R-time response did not differ with respect to age, and the PVi before transfusions but it was affected by the amount FFP and the resulting ΔPV (483 ± 173 vs. 296 ± 99 and 17.0% ± 6.6% vs. 8.6% ± 3.0%; p < 0.05).

Conclusions

We conclude that: 1) The amount of FFP required to normalize the R-time is lower than the recommended dose of 10–20 ml/kg: 2) 6.8 ml/kg of FFP, corresponding to an initial administration of two units of FFP (~ 500 ml) will provide an increase of 15.6% in the concentration of coagulation factors sufficient to normalize the R-time: 3) The assessment of PVi is the key element required to estimate the volume of FFP needed to correct a prolonged R-time.