Introduction
An energy drink is a type of beverage containing stimulant drugs, chiefly caffeine which is marketed as providing mental and physical stimulation. They may or may not be carbonate and may also contain sugar or otherwise sweeteners, herbal extracts and amino acids. There are many brands and verities of energy drinks. Coffee, tea and other naturally caffeinated beverages are usually not considered as energy drinks (Roberto, 2014). Some energy drinks have no caffeine but instead use the stimulant Guarana which is equivalent of caffeine.
Coagulation is the process by which blood changes from liquid to gel and it potentially result in haemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism of coagulation involves activation, adhesion, deposition and maturation of fibrin (David et al, 2009). Coagulation factors are proteins in the blood that are essential for coagulation. Clotting factors circulate in the blood as inert protein until the coagulation cascade initiates their conversion into participant in blood clotting. Clotting factors interact with each other as well as other enzymes in the blood, notable fibrin and thrombin to form blood clots.
Energy drink ingredients
Caffeine
Caffeine is the most widely used drug on the plant and was been used for centuries for its stimulating effects. Caffeine is found in varying quantity in seeds, leaves and fruits of some plants. In humans, caffeine acts as a central nervous system stimulant temporally coding off drowsiness and restoring alertness (Loveth, 2005). Caffeine has a wide range of unpleasant physical and mental conditions including nervousness, irritability, restlessness, insomnia, headache and heart palpitation.
Taurine
Taurine or 2-aminoethane sulphonic acid is an organic acid widely distributed in animal tissue. It is a major constituent for bile and can be found in the large intestine and accounts for up to 0.1% of total human body weight. Taurine has many fundamental biological roles such as conjugation of bile acids, osmo-regulation, membrane stabilization and modulation of calcium signalling. Taurine in combination with caffeine in energy drinks weaken platelet function. According to Santhakunar,taurine as an antioxidant inhibits platelet activity and may be instrumental in reducing the risk of thrombosis (Santhakumar et al, 2012).
Guarana
Guarana is used in sweetened or carbonated soft drinks and energy shots as its seed contain about twice the concentration of caffeine in coffee beans as with other plants producing coffee. Guarana extracts reduce aggregation of rabbit platelet by up to 3.7% below control values (Weinberg and Bealer, 2001).
Ginkgo Biloba
There are many conflicting results from basic research on ginkgo and its extract may have three effects on the human body. Improvement in blood flow to most tissue and organs, protection against oxidant cell damage from free radicals, blockage of many of the effects of platelet activating factors that have been related to the development of a number of cardiovascular, renal and respiratory system disorders and other ingredient include acai berry creatine yerba mate, B-vitamin and glucuronolactone which are used for boosting energy.
Coagulation factors
Coagulation factors interact with each other as well as other enzymes in the blood to form blood clots. Deficiencies of specific clotting factors cause coagulation disorder such as haemophilia (excessive bleeding) and thrombophilia (excessive clot formation). The liver produces clothing factors such as fibrinogen, prothrombin, cotromboplastin, plasma thromboplasting and Stuart power factor. Each coagulation factors also have one or more synonyms’ which are;
Factor Most common synonym
i Fibrinogen
ii Prothrombin
iii Tissue thromboplastin
iv Calcium ions
v Proaccelerin
vii Proconvertin/cothromboplastin
viii Anti haemophilic factors
ix Chrismas factor
x Stuart power factor
xi Plasma thromboplastin antecedent
xii Hageman factor
xiii Fibrin stabilizing factors
Mechanism of coagulation
Coagulation involves a series of delicately balanced physical and biochemical changes following an injury to a blood vessel. As the most immediate response, the blood vessels constrict reducing the volume of blood flowing out. The platelets aggregate at the site of the injury and form a plug which further reduces the bleeding. These activated platelets secrete substances that initiate the coagulation factors. The factors interact serially, forming a fibrin-network or clot in which cells, red cells and platelet are enmeshed and form a solid plug of blood (coagulation) which seals of the injury completely (Ochei and Kothatkar, 2007).
The final product in the coagulation process is the fibrin clot formed by activation of prothrombin to form thrombin, which in turn converts fibrinogen to fibrin. There are two pathways leading to the activation of prothrombin, both lead to a common pathway (Hoffbrad, 2002).
Intrinsic pathway
In this pathway, all the necessary components are found within the circulating blood. When blood comes in contact with a foreign surface, a series of reaction mediated by enzymes start on contact with foreign surface perkallikrein and high molecular weight Kininogen (HMWK) participate in the activation of factors xii (hage man factors) to xiia. Xiia in turn activates factor xi (plasma thrombinplastin) to from xia. This process continues further involving factors ix (chismas factor) viii (antihaemophilic factor and x (stuart power factor). Factor x is converted to xa by the action of calcium ions and phospholids on the platelets.
Extrinsic pathway
The extrinsic pathway is initiated when there is tissue damage together with an injured blood vessel. The damage tissue release thromboplastin which is not normally present in the blood. This thromboplastin along with factors vii (cothromboplastin) in the presence of calcium, activates factors x to produce factor xa. The extrinsic pathway is much shorter and quick than the intrinsic.
Common pathway
The common pathway involves the activation of factor x to xa via the extrinsic or intrinsic pathway. Factors xa in the presence of calcium, platelet, tissue thromboplastin and proaccelerin converts prothrombin to the active enzyme thrombin. Thrombin acts on factor I (fibrinogen) to convert to fibrin factor xiii helps in the formation of stabilized, stronger clot.
Function of platelet in coagulation
Platelets are disc-shaped, non nucleated and are surrounded by a layer of proteins and carbohydrate which participate in coagulation.Platelet has three important functions which are;
- Form a platelet plug which offers a physical obstruction to blood loss. Adhesions of platelet to the exposed collagen fibres of the blood vessels start activation of platelet. Activated platelets change their form and become spherical with long projection.
- Helps in activation of coagulation factors and participate in the process of coagulation. Platelet produce a phospholipoprotein on their plasma membrane called platelet factor iii which is necessary for the activation of certain coagulation factors.
- Maintain the endothelial lining of the blood vessel. Platelet also secretes certain products which help to maintain and repair the endothelium of the blood vessels.
Diagnosis
Coagulation test measure the function of proteins essential for blood clot formation and the tests are;
- Ivy bleeding time
- Clotting time
- Clot retraction
- Prothrombin time
- Activated partial thromboplastin time
- Platelet count
Ivy bleeding time
Bleeding time measures the time required for the blood to stop flowing after a standardised capillary puncture.
Method
- Place a blood pressure cuff on the upper arm and inflate to 40mmHg
- Clean the area of the fore arm below the anticubital fossa with 70% alcohol. There should be no superficial veins in the area selected.
- Make two skin puncture in rapid succession each 3mm deep, using a disposable lancet.
- Start the stop watch as soon as bleeding starts wipe off the blood at 15 second interval by touching lightly with a blotting paper.
- Record the time for the blood to stop flowing in both puncture and determine the mean time. Remove the blood pressure cuff and cover the puncture site with plaster, normal range 2-6 minutes.
Conclusion
Energy drink consumption has been linked to inhibition of platelet function; energy drink has shown effect on blood coagulation as the ingredients of energy drink are known to inhabit platelet function, thus slowing the initiation of coagulation factors leading to longer bleeding time and slowing the process of platelet plug formation when there is damage to tissue.
Recommendation
Energy drink consumers should minimize the intake of large volumes due to its crash and burn effects. Patients to undergo surgery should abstain from consumption of energy drink as studies have shown increase bleeding with energy drink consumers.
References
David, L., Negel, K., Michael, M. and Denise,O. (2009).Practical Haemostasis and Thrombosis;. Oxford: Willey-Blackwell Pp,1-5.
Hoffbrand, A. V. (2002). Essential Haematology. Oxford: Blackwell Science Pp.243-245.
Lovett, R. (2005). Coffee the demon drinks? New Science Journal 1: 2518
Ochei, J. and Kolhatkar, A. (2007). Textbook of Medical laboratory Science Theory and Practical. New Delhi: Tata McGraw-Hill Publisher Pp: 333-346.
Roberto, F. (2014).The American energy drink craze in two highly Caffeinated charts quartz. Journal of Food Science 73(3): 74-82.
Santhakumar, A. B., Linden, M.D. and Singh, I. (2012). Taurine in lower Concentration attenuates platelet activity. Food and Public Health2:58-64.
Weinberg, B.A. and Beaker, B.K. (2001). The world of caffeine. The Science and Culture of the World’s most Popular Drug New York: Routledge 102: 230-239.
