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Has the body temperature an impact on blood loss?

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We can expect that trauma patients can be hypothermic due to trauma conditions and during the procedures and interventions in the emergency room. We hear many patients after surgery saying “it was so cold.” Has the body temperature an impact on blood loss?
asked Jul 17, 2012 in Conditions and Treatments by Hatice Simsek MD (3,070 points)

4 Answers

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I once read an article online which stated that cold reduces clotting time.  I also saw a documentary, and one professor was quoted as saying that cold temperature was very instrumental in the survival of soldiers during war, specifically in the Falkland Island war.  I am also very interested in inducing hypothermia in truama to prevent shock.
answered Jul 20, 2012 by anonymous
edited Jul 20, 2012 by jlvarisco
Clotting time will increase according to the article. I am SORRY for writing that it will "reduce cloting time".
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Yes - Body temperature has an effect on blood loss.  Hypothermia affects haemostasis.

 

Haematological

 

One of the most widely documented effects of hypothermia is coagulopathy. Hypothermia affects haemostasis on several levels: 

 

 

  • Platelet function

  • Coagulation cascade

  • Fibrinolytic system

 

Platelet function

 

Early animal studies have shown that hypothermia causes reversible platelet sequestration in the liver and spleen. Hypothermia also directly affects platelet function by decreasing production of thromboxane B2 and expression of platelet surface molecules.

 

Coagulation cascade

 

When clotting assays are performed at temperatures below 37°C, the results are significantly prolonged. Prothrombin time is significantly increased at temperatures below 35°C, and activated partial thromboplastin time is similarly prolonged at temperatures below 33°C. In contrast, when clotting tests using blood from hypothermic rats are performed at 37°C, no significant abnormalities are seen. This suggests that the major mechanism of hypothermia-induced coagulopathy results from altered enzymatic activity. In fact, at 33°C the clotting process is functionally equivalent to having a 33% factor-IX deficiency, even in the presence of normal clotting factor levels. These effects are directly reversible with the correction of hypothermia, emphasizing the importance of maintaining normal core temperatures in injured patients.

 

Fibrinolytic system

 

Fibrinolysis is increased in hypothermic animals, and is felt to be as a result of impaired inhibitors of clot lysis, such as plasminogen activator inhibitor or alpha-2-antiplasmin. In the clinical setting, the trauma patient’s coagulation profile may be reported as normal, as the sample is usually heated to 37°C in the laboratory before it is tested.

 

References

 

Hypothermia in the trauma patient; Injury, Volume 35, Issue 1, January 2004, Pages 7-15; Betty J. Tsuei and Paul A. Kearney

 

Read entire article

answered Jul 20, 2012 by Jan B. Wade (4,930 points)
edited Jul 20, 2012 by Jan B. Wade

 

Anesthesiology:
January 2008 - Volume 108 - Issue 1 - pp 71-77
doi: 10.1097/01.anes.0000296719.73450.52
Clinical Investigations

The Effects of Mild Perioperative Hypothermia on Blood Loss and Transfusion Requirement

 

Rajagopalan, Suman M.D.*; Mascha, Edward Ph.D.†; Na, Jie M.S.‡; Sessler, Daniel I. M.D.
 

 

Abstract
 
Background: Anesthetic-induced hypothermia is known to reduce platelet function and impair enzymes of the coagulation cascade. The objective of this meta-analysis and systematic review was to evaluate the hypothesis that mild perioperative hypothermia increases surgical blood loss and transfusion requirement.
Methods: The authors conducted a systematic search of published randomized trials that compared blood loss and/or transfusion requirements in normothermic and mildly hypothermic (34–36°C) surgical patients. Results are expressed as a ratio of the means or relative risks and 95% confidence intervals (CI); P < 0.05 was considered statistically significant.
 
Results: Fourteen studies were included in analysis of blood loss, and 10 in the transfusion analysis. The median (quartiles) temperature difference between the normothermic and hypothermic patients among studies was 0.85°C (0.60°C versus 1.1°C). The ratio of geometric means of total blood loss in the normothermic and hypothermic patients was 0.84 (0.74 versus 0.96), P = 0.009. Normothermia also reduced transfusion requirement, with an overall estimated relative risk of 0.78 (95% CI 0.63, 0.97), P = 0.027.
 
Conclusion: Even mild hypothermia (<1°C) significantly increases blood loss by approximately 16% (4–26%) and increases the relative risk for transfusion by approximately 22% (3–37%). Maintaining perioperative normothermia reduces blood loss and transfusion requirement by clinically important amounts.

From Anesthesiology 

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Although the simplest mechanism in hypothermia is vasoconstriction, particularly of the capillary bed.
answered Jul 20, 2012 by anonymous
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J Trauma Acute Care Surg. 2012 Nov;73(5):1195-201. doi: 10.1097/TA.0b013e31826fc7d9.

Impact of prehospital hypothermia on transfusion requirements and outcomes.

Source

From the Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.

Abstract

BACKGROUND:

Prehospital hypothermia (PH) is known to increase mortality following traumatic injury. PH relationship with transfusion requirements has not been documented. The purpose of this investigation was to analyze the impact of PH on blood product requirements and subsequent outcomes.

METHODS:

The Los Angeles County Trauma System Database was queried for all patients admitted between 2005 and 2009. Demographics, physiologic parameters, and transfusion requirements were obtained and dichotomized by admission temperatures with a core temperature of less than 36.5°C considered hypothermic. Multivariate analysis was performed to determine factors contributing to transfusion requirements and to derive adjusted odds ratios (AORs) for mortality and rates of adult respiratory distress syndrome and pneumonia.

RESULTS:

A total of 21,023 patients were analyzed in our study with 44.6% presenting with PH. Hypothermic patients required 26% more fluid resuscitation (p < 0.001) in the emergency department and 17% more total blood products (p < 0.001) than those who were admitted with a normal temperature. There was a trend toward an increase in emergency department transfusion (8%, p = 0.06). PH was independently associated with the need for a transfusion (AOR, 1.1; p = 0.047), increased mortality (AOR, 2.0; p < 0.01), as well as incidence of adult respiratory distress syndrome (AOR, 1.8; p < 0.05) and pneumonia (AOR, 2.6; p < 0.01).

CONCLUSION:

PH is associated with increased transfusion and fluid requirements and subsequently worse outcomes. Interventions that correct hypothermia may decrease transfusion requirements and improve outcomes. Prospective studies investigating correction of hypothermia in trauma patients are warranted.

LEVEL OF EVIDENCE:

Prognostic/epidemiologic study, level III.

 

answered Nov 27, 2012 by Hatice Simsek MD (3,070 points)

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