Perfluorochemical blood substitutes differentially alter human monocyte procoagulant generation and oxidative metabolism.

Human blood mononuclear leukocytes exposed in vitro to perfluorochemical blood substitutes (Fluosol-DA and FC-43) generated increased procoagulant activity that was time dependent. Mononuclear leukocytes incubated with 10 percent Fluosol-DA for 4 hours generated 3.43-fold more procoagulant activity than control cells. At 24 hours of incubation with 10 percent Fluosol-DA, cells generated 10.49-fold more procoagulant than control. Cells incubated with 10 or 20 percent FC-43 generated 2.5- or 3.4-fold greater procoagulant than controls, respectively. The perfluorochemical emulsifier (Pluronic F68) also stimulated 3.4-fold more activity than control cells. Stimulated oxidative metabolism (superoxide anion generation) was significantly impaired by Fluosol-DA but not by FC-43 or Pluronic F68. No significant perfluorochemical-induced cytotoxicity was measured by trypan blue dye exclusion or lactate dehydrogenase release. Electron microscopic analysis showed progressive uptake of the perfluorochemicals by monocytes but not by lymphocytes. Thus, perfluorochemicals may differentially activate cellular initiators of coagulation while impairing other metabolic responses of mononuclear phagocytes. Patients receiving perfluorochemical preparations should be monitored for abnormalities of hemostasis and for disorders of the mononuclear phagocyte system.