The Effects of Temperature on Clot Microstructure and Strength in Healthy Volunteers

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Author
Lawrence, Matthew
Marsden, Nick
Mothukuri, Rangaswamy
Morris, Keith
Davies, Gareth
Hawkins, Karl
Curtis, Daniel
Brown, Martin
Williams, Phylip
Evans, Phillip
Date
2016-01Acceptance date
2015-07-07
Type
Article
ISSN
0003-2999
1526-7598 (ESSN)
Embargoed until
2100-01-01
Metadata
Show full item recordAbstract
BACKGROUND: Anesthesia, critical illness, and trauma are known to alter thermoregulation, which can potentially affect coagulation and clinical outcome. This in vitro preclinical study explores the relationship between temperature change and hemostasis using a recently validated viscoelastic technique. We hypothesize that temperature change will cause significant alterations in the microstructural properties of clot. METHODS: We used a novel viscoelastic technique to identify the gel point of the blood. The gel point identifies the transition of the blood from a viscoelastic liquid to a viscoelastic solid state. Furthermore, identification of the gel point provides 3 related biomarkers: the elastic modulus at the gel point, which is a measure of clot elasticity; the time to the gel point (TGP), which is a measure of the time required to form the clot; and the fractal dimension of the clot at the gel point, df, which quantifies the microstructure of the clot. The gel point measurements were performed in vitro on whole blood samples from 136 healthy volunteers over a temperature range of 27°C to 43°C. RESULTS: There was a significant negative correlation between increases in temperature, from 27°C to 43°C, and TGP (r = −0.641, P < 0.0005). Conversely, significant positive correlations were observed for both the elastic modulus at the gel point (r = 0.513, P = 0.0008) and df (r = 0.777, P < 0.0005) across the range of 27°C to 43°C. When temperature was reduced below 37°C, significant reductions in df and TGP occurred at ≤32°C (Bonferroni-corrected P = 0.0093) and ≤29°C (Bonferroni-corrected P = 0.0317), respectively. No significant changes were observed when temperature was increased to >37°C. CONCLUSIONS: This study demonstrates that the gel point technique can identify alterations in clot microstructure because of changes in temperature. This was demonstrated in slower-forming clots with less structural complexity as temperature is decreased. We also found that significant changes in clot microstructure occurred when the temperature was ≤32°C.
Journal/conference proceeding
Anesthesia & Analgesia
Citation
Lawrence, M.J., Marsden, N., Mothukuri, R., Morris, R.H.K., Davies, G., Hawkins, K., Curtis, D.J., Brown, M.R., Williams, P.R. and Evans, P.A. (2016) 'The effects of temperature on clot microstructure and strength in healthy volunteers', Anesthesia & Analgesia, 122(1), pp.21-26.
Description
This article was published in Anesthesia & Analgesia in January 2016 (online), available at http://dx.doi.org/10.1213/ANE.0000000000000992
Sponsorship
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
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