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).

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.