The influence of the haematocrit on primary haemostasis in vitro

Primary haemostasis consists of platelet adhesion to sub-endothelial collagen, their activation and aggregation and finally the formation of a platelet plug. Erythrocytes are involved in this process because they flow in the center of the vessel and push platelets towards the site of action on the vessel wall and enhance shear forces, which activate platelets. In the platelet function analyzer PFA-100 (R) (Dade Behring, Dudingen, Switzerland),the in vivo situation is simulated in vitro with blood being aspirated at high shear rates (5000s(-l)) through a capillary into a membrane pore with a diameter of 150 mu m coated with type I collagen and either epinephrine or adenosine diphosphate. Aggregating platelets plug the pore and stop the flow, which is measured as the closure time. We analysed the influence of erythrocytes on platelet function analyzer measurements by systematic variation of the haematocrit (20,30,40,and 50%) at constant platelet counts of 289 +/- 61 x 10(3)/mu l plasma, or 152 +/- 30 x 10(3)/mu l blood, 96 +/- 9 x 10(3)/mu l blood and 54 +/- 5 x 10(3)/mu l blood, respectively. An inverse correlation was found between haematocrit and closure time under all circumstances. A decrease of the platelet count by 50 x 10(3)/mu l could be compensated for by a 10% increase in haematocrit. The haematocrit must, therefore, be taken into consideration for the correct interpretation of PFA- 100 (R) measurements. Our data also provide a pathophysiological rationale to reduce the risk of bleeding in patients with thrombocytopenia and anaemia by normalizing the haernatocrit with erythrocyte transfusions.