Characterizing the Impact of Transfusion Products on Blood Clot Failure

Background: Following injury, blood clots must be mechanically strong to resist failure and prevent bleeding. Resuscitation strategies aim to accommodate oxygen transport and coagulation properties of blood. However, limited research defines how transfusion influences clot mechanics. Objectives: We aimed to define how transfusion products affect clot mechanics and fibrin structure.

Methods: A simulated trauma induced dilutional coagulopathy (STIC) model was created by diluting 2.5 mg/mL fibrinogen platelet-poor plasma 15% by saline and activating with 20 mM CaCl2 and 1 pM or 45 pM tissue factor to simulate coagulation kinetics in a previous patient study. Transfusion was recreated by supplementing the model with resuscitative fluids; plasma, saline, and fibrinogen concentrate (FibConc), at levels observed in the patient study. Mechanics were measured using a Biomomentum mechanical tester, applying uniaxial tension. Clots were imaged using confocal microscopy, measuring network changes. One way ANOVA was used to assess group differences. Results: In both hypocoagulable (1 pM) and hypercoagulable (45 pM) clots; plasma and FibConc increased rupture resistance, restoring control levels (Figure 1A–D). Saline reduced mechanical properties in both activation conditions, indicating poor rupture resistance compared to other samples (Figure 1A–D). Fibrin network structure analysis indicates a restoration of the fibrin network density utilizing plasma and FibConc, while saline led to a reduction in fibrin fiber density relating to the reduction in maximum force at failure observed (Figure 1E–G). Conclusion: Simulating the impact of transfusion on clot failure properties indicates the influence of each component on clot failure and have implications for transfusion guidance after trauma. Future work will focus on using whole blood, platelets, and combined blood products.