Mechanisms of Physical Plasma-Incuded Blood Coagualtion: What Happens at the Treatment-Interface?

Major blood loss is a risk factor during surgery. Electrocauterization is frequently applied for necrotizing the tissue and thereby stops bleeding (hemostasis). However, the burned tissue is prone to detaching, generating the risk of internal bleeding after surgery. Plasma treatment might be an alternative to efficient hemostasis, which we have previously demonstrated in a mouse model and in human donor blood 1,2 . However, the underlying mechanisms have not been yet elucidated. We found plasma treatment to efficiently coagulated anticoagulated donor blood, which resulted from the local lysis of red blood cells (hemolysis) 3 . Using image cytometry further showed enhanced platelet aggregation. The plasma jet kINPen was used, which releases reactive oxygen species (ROS), but neither scavenging of long-lived ROS nor addition of chemically-generated ROS were able to abrogate or recapitulate the gas plasma effect. Yet, platelet activation was markedly impaired in platelet-rich plasma when compared to plasma-treated whole blood that moreover contained significant amounts of hemoglobin indicative of red blood cell lysis (hemolysis). Interestingly, incubation of whole blood with concentration-matched hemolysates phenocopied the plasmas-mediated platelet activation. Hence, we identified hemolysis being the main mechanism of plasma-induced blood coagulation via platelet activation.