Essential metallic elements are necessary for various metabolic processes, signalling pathways in the human body and coagulation function [1], [2], [3], [4], [5]. Several individual metallic elements have been demonstrated to have pro-coagulative effects [6]. In haemostasis, zinc (Zn) is able to regulate platelet aggregation, coagulation, and fibrin network formation, and its intracellular state can affect the reactivity of platelets by regulating the actual cytoplasmic calcium (Ca) level [7]. Exposure to pollutants containing Zn and vanadium (V) shortened coagulation time [8]. Raised copper (Cu) levels have been proven to activate an anticoagulant effect [9]. After being exposed to selenium (Se), prolonged clotting time and PT time were reported in an animal experiment [8], [10]. A reduced level of Se was associated with increased mean platelet volume and reduced thrombocyte count [3], [11].

Trauma-induced coagulopathy (TIC) is a multifactorial and complicated failure of haemostasis, associated with significant morbidity and mortality [12]. Although its pathophysiology remains elusive, many investigations have identified that circulating platelets were in an acute stage of dysfunction after severe injury, which might contribute to the pathogenesis of TIC and result in poor outcomes [13]. As a result, changes in platelet function have attracted scientific attention as it may be one of the important determinants of TIC [12]. Since excessive platelet activation with subsequent exhaustion is one of the proposed mechanisms of TIC, platelet and plasma transfusion have been proposed as one of the treatments for TIC [14]. Early appropriate care for trauma patients is a multidisciplinary task, however, clinicians have found that platelet and plasma transfusion, somehow, were not always able to rectify post-traumatic platelet dysfunction [15], [16].

It has been reported that disorders of metallic elements are playing a role in injury severity and clinical outcome in trauma patients [17]. However, the correlation between metallic elements and platelet dysfunction in TIC has not been fully explored. We therefore propose that disorders of metallic elements may have a role in the pathogenesis of post-traumatic diseases, especially TIC. Thus, the aim of this study was to investigate post-traumatic disorders of metallic elements and their impact on platelet dysfunction in TIC, in order to explore the potential therapeutic role of metallic element supplements in the management of trauma patients.