Critical Care

, 16:P429 | Cite as

Templating effect of clot structure can predict clot development and outcome in diluted blood: a comparison with thromboelastography

  • M Lawrence
  • J Kaczynski
  • S Stanford
  • R Morris
  • P Evans
Poster presentation


Fractal Dimension Oscillatory Shear Dilution Ratio Healthy Sample Dilute Blood 
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Treatment of major hemorrhage with colloids is known to have an effect on clot outcome. However, determining both the rate and extent of these changes is difficult. Development of a new biomarker has shown that it can detect structural development earlier and quantifies these changes to clot outcome accurately when compared to other methods. This study compares the fractal dimension, Df [1], found when the clot first forms to measures of mature clot firmness obtained from thromboelastography.


Forty healthy blood samples were obtained; each sample was allocated a random dilution ratio (10%, 20%, 40%, 60%) and diluted with gelofusine. These were matched with 40 healthy samples that were undiluted. An oscillatory shear technique was applied to the blood using an AR-G2 measuring Df (clot structure). Additionally the clot development in terms of firmness was measured using a ROTEM analyser measuring at 5, 10, 15 minutes and its maximum (A5, A10, A15, MCF).


Df significantly decreases with increasing dilution. The decrease in structural complexity indicates that gelofusine even at 40% dilution is producing poor quality clots. See Table 1.
Table 1

Change in Df with dilution

Dilution %



1.74 (0.05)


1.72 (0.04)


1.70 (0.06)


1.63 (0.05)


1.59 (0.06)

*Significant decrease from 0%.


Df that is measured at the incipient clot is found much sooner than the mature clot parameters, between 5 and 30 minutes earlier. Df is significantly correlated (P < 0.05) with the mature clot parameters of clot firmness (A5, A10, A15 and MCF) and elasticity (G'max). This suggests that in dilution Df can determine the eventual clot outcome very early. Measurement of Df could guide fluid replacement and component therapy more accurately and earlier than conventional markers.


  1. 1.
    Evans P, et al.: Blood. 2010, 116: 3341-3346. 10.1182/blood-2010-02-269324CrossRefPubMedGoogle Scholar

Copyright information

© Lawrence et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • M Lawrence
    • 1
  • J Kaczynski
    • 2
  • S Stanford
    • 1
  • R Morris
    • 3
  • P Evans
    • 2
  1. 1.Swansea UniversitySwanseaUK
  2. 2.ABMU LHBSwanseaUK
  3. 3.UWICCardiffUK

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