Hemoperitonium Increases Carbon Monoxide and Reduces Platelet Aggregation in Trauma Patients

Abstract

Hemorrhage into body cavities is a common complication from blunt trauma. While it used to be standard practice to clear such a hemoperitoneum, more recently they been left untreated due to various concerns with patient stability.ObjectiveDetermine if hemoperitoneum elevates carbon monoxide production and impairs platelet aggregation in trauma patients.MethodsMale patients with verified hemoperitoneum were enrolled along with non‐hemoperitoneum head injury controls. Three days after admission, whole patient carbon monoxide excretion was measured via solid‐phase gas chromatography. A blood sample was drawn to evaluate collagen‐ and thrombin‐induced aggregation.ResultsThree days after injury, patients with hemoperitoneum displayed higher carbon monoxide excretion (0.54±0.10 vs 0.96±0.11 μmol/Kg per hr, control vs hemoperitoneum, P<0.05), and carboxyhemoglobin levels 24% higher than the non‐hemoperitoneum controls. Patients with hemoperitoneum also displayed decreased amplitude of both collagen and thrombin activated platelet aggregation (−23 and − 34%, respectively).ConclusionsAbdominal blood drives endogenous carbon monoxide formation and interferes with hemostatic processes, so inhibitors of carbon monoxide formation may potentially serve as a therapeutic to stabilize affected patients. Supported by grants Department of Army #W81XWH‐07‐1‐0717 (RAJ and RMS), AHA 0865241F (FKJ) and NIH HL064577 (RAJ).