The Korean Journal of Physiology and Pharmacology

The Korean Society of Pharmacology (대한약리학회)
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A simple and novel equation to estimate the degree of bleeding in haemorrhagic shock: mathematical derivation and preliminary in vivo validation

  • Chon, Sung-Bin (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Lee, Min Ji (Department of Emergency Medicine, CHA Bundang Medical Center) ;
  • Oh, Won Sup (Department of Internal Medicine, Kangwon National University Hospital) ;
  • Park, Ye Jin (Department of Emergency Medicine, CHA Bundang Medical Center) ;
  • Kwon, Joon-Myoung (Department of Critical Care and Emergency Medicine, Mediplex Sejong Hospital) ;
  • Kim, Kyuseok (Department of Emergency Medicine, CHA Bundang Medical Center)
  • Received : 2022.02.03
  • Accepted : 2022.03.18
  • Published : 2022.05.01
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Abstract

Determining blood loss [100% - RBV (%)] is challenging in the management of haemorrhagic shock. We derived an equation estimating RBV (%) via serial haematocrits (Hct1, Hct2) by fixing infused crystalloid fluid volume (N) as [0.015 × body weight (g)]. Then, we validated it in vivo. Mathematically, the following estimation equation was derived: RBV (%) = 24k / [(Hct1 / Hct2) -1]. For validation, non-ongoing haemorrhagic shock was induced in Sprague-Dawley rats by withdrawing 20.0%-60.0% of their total blood volume (TBV) in 5.0% intervals (n = 9). Hct1 was checked after 10 min and normal saline N cc was infused over 10 min. Hct2 was checked five minutes later. We applied a linear equation to explain RBV (%) with 1 / [(Hct1 / Hct2) -1]. Seven rats losing 30.0%-60.0% of their TBV suffered shock persistently. For them, RBV (%) was updated as 5.67 / [(Hct1 / Hct2) -1] + 32.8 (95% confidence interval [CI] of the slope: 3.14-8.21, p = 0.002, R2 = 0.87). On a Bland-Altman plot, the difference between the estimated and actual RBV was 0.00 ± 4.03%; the 95% CIs of the limits of agreements were included within the pre-determined criterion of validation (< 20%). For rats suffering from persistent, non-ongoing haemorrhagic shock, we derived and validated a simple equation estimating RBV (%). This enables the calculation of blood loss via information on serial haematocrits under a fixed N. Clinical validation is required before utilisation for emergency care of haemorrhagic shock.

Keywords

Acknowledgement

The authors express their cordial gratitude to Prof. Sang Do Shin for his insightful mentoring in this study. We also appreciate Miss Ha Eun Lee, BS, and Ye-Hee Chon for their help in performing the experiment and drafting figures, respectively. We thank Editage.com for English language editing.

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