From the Division of GI, Trauma, and Endocrine, Department of Surgery (M.D., M.K., T.R.S., E.E.M., A.S., A.C., M.J.C., C.C.S., J.C.), Trauma Research Center and Department of Biochemistry and Molecular Genetics (C.E., I.L., A.D., K.H.), School of Medicine, University of Colorado, Aurora, Colorado; Vitalent Mountain Division (M.K., C.C.S.), Vitalant Research Institute; Ernest E Moore Shock Trauma Center (E.E.M.), Denver Health Medical Center, Denver; Department of Health Systems (A.S.), School of Public Health, Management and Policy, University of Colorado, Aurora, Colorado.
J Trauma Acute Care Surg. 2023 Apr 1;94(4):497-503. doi: 10.1097/TA.0000000000003857. Epub 2023 Jan 11.
Females are relatively hypercoagulable compared with males, with increased platelet aggregation and improved clot dynamics. However, sex differences in coagulation have not yet been considered in transfusion guidelines. Therefore, our objective was to evaluate hemostatic differences in sex concordant and sex discordant cryoprecipitate and platelet transfusions. We hypothesized that transfusion of blood products from female donors results in improved coagulopathy compared with male blood products.
This was a cohort study evaluating sex dimorphisms in coagulation assays and clotting factors in healthy volunteer plasma and cryoprecipitate. Sex dimorphisms in transfusions were evaluated using an in vitro coagulopathy model. Female or male platelets or single-donor cryoprecipitate was added to "recipient" whole blood after dilution of recipient blood with citrated saline to provoke a coagulopathic profile. Citrated native thromboelastography was then performed. Liquid chromatography/mass spectroscopy was performed on single-donor cryoprecipitate to evaluate sex dimorphisms in the proteome of cryoprecipitate.
Females have an increased proportion of functional fibrinogen. Transfusion of female-donor platelets and cryoprecipitate induces a larger decrease in R time and greater increase in angle than male-donor platelets or cryoprecipitate. Female-donor cryoprecipitate has increased factor V and factor XIII compared with male cryoprecipitate, and comprehensive proteomics revealed sex differences in several proteins with potential immunological significance.
Platelets and cryoprecipitate from female donors improve coagulopathy more than male blood products in vitro. Increased factor V and factor XIII activity as well as increased fibrinogen activity in female donors appears to drive this disparity. Sex differences in the proteome of cryoprecipitate may influence how transfusions modulate the thromboinflammation of trauma. The differing hemostatic profiles of female and male blood products suggest the potential role of sex-specific transfusions guidelines in hemostatic resuscitation.
与男性相比，女性的凝血功能相对亢进，血小板聚集增加，血栓动力学改善。然而，输血指南尚未考虑凝血功能的性别差异。因此，我们的目的是评估性别一致和性别不一致的冷沉淀和血小板输血的止血差异。我们假设输注女性供体的血液制品与男性血液制品相比，可改善凝血功能障碍。
这是一项队列研究，评估了健康志愿者血浆和冷沉淀中凝血功能的性别二态性。使用体外凝血功能障碍模型评估输血中的性别二态性。将女性或男性血小板或单采冷沉淀添加到用柠檬酸盐盐水稀释的“受体”全血中，以引发凝血功能障碍。然后进行枸橼酸钠血栓弹性描记术。对单采冷沉淀进行液相色谱/质谱分析，以评估冷沉淀蛋白组中的性别二态性。
女性具有更高比例的功能性纤维蛋白原。输注女性供体的血小板和冷沉淀会导致 R 时间明显缩短，角度明显增加，而输注男性供体的血小板或冷沉淀则不会。与男性冷沉淀相比，女性供体的冷沉淀中因子 V 和因子 XIII 增加，全面蛋白质组学显示，几种具有潜在免疫意义的蛋白质存在性别差异。
与男性血液制品相比，来自女性供体的血小板和冷沉淀在体外可改善凝血功能障碍。女性供体中因子 V 和因子 XIII 活性增加以及纤维蛋白原活性增加似乎导致了这种差异。冷沉淀蛋白组中的性别差异可能影响输血如何调节创伤的血栓炎症。女性和男性血液制品的止血特征不同，提示性别特异性输血指南在止血复苏中的潜在作用。
