D i e t m a r F r i e s , E l i s a b e t h K o r n b e r g e r, A n g e l i k a S t a l l i n g e r, Wo l f g a n g S c h o b e r s b e r g e r
Hypothermie und Gerinnung The effect of hypothermia on the coagulation system S U M M A RY A major part of all trauma-victims suffer from hypothermia. In case of traumatic bleeding or a following surgical procedure, hypothermia is associated with coagulation disorders and probably huge blood loss. In-vitro investigations performed at hypothermic temperatures showed prolonged clotting times. Apart the impaired plasmatic side of hemostasis, decreased platelet-count, harmed platelet adhesion and aggregation as well as activated fibrinolysis was found in animal studies. The critical body temperature seems to be between 34 ˚C and 35 ˚C. Below this temperature, the coagulation system was impaired significantly more referring to thrombelastographic measurements and blood loss was significantly higher in trauma patients with a body core temperature below 35 ˚C compared to normothermic patients. Standardised coagulation assays performed at 37 ˚C do not accurately reflect the magnitude of clotting dysfunction in hypothermic patients. Thus, it is not possible to detect the extent of hypothermic coagulation disorders by using the routine laboratory test methods, which are usually not adjusted to the patient’s actual body core temperature. The treatment of a hypothermic coagulation disorder is re-warming in the first line. If huge blood losses cause a dilution or depletion coagulopathy beneath the hypothermic coagulation disorder,fresh frozen plasma and/or clotting factors are indicated. However, also these substitutes have a lower activity at low body core temperatures. Keywords: Hypothermia, trauma, coagulation, fibrinolysis, platelets.
Z U S A M M E N FA S S U N G Hypothermie ist eine Komplikation, welche den Großteil aller Traumapatienten v. a. nach Alpinunfällen und längeren Bergezeiten betrifft. Im Rahmen einer anschließenden operativen Versorgung kann es dann zu
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