Fresh and Citrated Whole-Blood Specimens Can Produce Different Thromboelastography Results in Patients on Extracorporeal Membrane Oxygenation

Gilman, Elizabeth A.; Koch, Christopher D.; Santrach, Paula J.; Schears, Gregory J.; Karon, Brad S.

doi:10.1309/ajcpyiq9jnnsen4q

Cited by 21 publications

(19 citation statements)

References 10 publications

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“…Whole blood for ROTEM and TEG analysis is usually collected in sodium citrated Vacutainer® tubes and then recitrated when the whole blood sample is pipetted into the sample cup. However, TEG analyses done on citrated whole blood samples are known to produce profiles, which are artifactually hypercoagulable relative to uncitrated samples, and recently citrated TEG analyses were demonstrated to produce profiles artifactually consistent with unfractionated heparin reversal in some ECMO patients . The standard ROTEM and TEG assays are summarized in Tables and .…”

Section: Technologymentioning

confidence: 99%

TEG and ROTEM: Technology and clinical applications

2014

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Initially described in 1948 by Hertert thromboelastography (TEG) provides a real-time assessment of viscoelastic clot strength in whole blood. Rotational thromboelastometry (ROTEM) evolved from TEG technology and both devices generate output by transducing changes in the viscoelastic strength of a small sample of clotting blood (300 ml) to which a constant rotational force is applied. These point of care devices allow visual assessment of blood coagulation from clot formation, through propagation, and stabilization, until clot dissolution. Computer analysis of the output allows sophisticated clot formation/dissolution kinetics and clot strength data to be generated. Activation of clot formation can be initiated with both intrinsic (kaolin, ellagic acid) and extrinsic (tissue factor) activators. In addition, the independent contributions of platelets and fibrinogen to final clot strength can be assessed using added platelet inhibitors (abciximab and cytochalasin D). Increasingly, ROTEM and TEG analysis is being incorporated in vertical algorithms to diagnose and treat bleeding in high-risk populations such as those undergoing cardiac surgery or suffering from blunt trauma. Some evidence suggests these algorithms might reduce transfusions, but further study is needed to assess patient outcomes.

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Section: Technologymentioning

confidence: 99%

TEG and ROTEM: Technology and clinical applications

2014

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“…Moreover, similarly to D-dimers and SFC, correlation between methods is moderate, and inter-laboratory variation is high [ 99 ], but probably improving with introduction of new methods (ROTEM Sigma®, TEG6S® and Quantra®). Regarding preanalytical conditions, the time-interval between blood collection and VET [ 100 , 101 ], anticoagulants and/or additives used in sample tubes [ 102 , 103 ], over or underfilling of blood tubes [ 104 ], hemolysis [ 105 ] and hematocrit [ 106 – 108 ] can influence the test results. Pneumatic tubes transport systems (PTS) may also exert little influence on test results, depending on acceleration forces of the local system [ 109 – 112 ].…”

Section: Hemostasis Assessment In the Laboratorymentioning

confidence: 99%

Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

Hardy¹,

Lecompte

Douxfils

et al. 2020

Thrombosis J

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Coronavirus disease 2019 (COVID-19) is associated with extreme inflammatory response, disordered hemostasis and high thrombotic risk. A high incidence of thromboembolic events has been reported despite thromboprophylaxis, raising the question of a more effective anticoagulation. First-line hemostasis tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and D-dimers are proposed for assessing thrombotic risk and monitoring hemostasis, but are vulnerable to many drawbacks affecting their reliability and clinical relevance. Specialized hemostasis-related tests (soluble fibrin complexes, tests assessing fibrinolytic capacity, viscoelastic tests, thrombin generation) may have an interest to assess the thrombotic risk associated with COVID-19. Another challenge for the hemostasis laboratory is the monitoring of heparin treatment, especially unfractionated heparin in the setting of an extreme inflammatory response. This review aimed at evaluating the role of hemostasis tests in the management of COVID-19 and discussing their main limitations.

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“…TEG assays obtained using citrated whole blood, however, appear to be hypercoagulable, artifactually, when compared to non‐citrated whole blood (Wasowicz et al , ). For example, in patients requiring extracorporeal membrane oxygenation (ECMO), TEG analysis of citrated and un‐citrated samples demonstrated this phenomenon upon heparin reversal (Gilman et al , ). Regarding the trigger reagents, kaolin is provided with standard vials in order to simplify the procedure, but distinguishing thrombocytopenia from dilutional coagulopathy in ROTEM assays with kaolin reagents would appear to be difficult (Larsen et al , ).…”

Section: Techniques and Analysesmentioning

confidence: 99%

The utility of thromboelastography in inherited and acquired bleeding disorders

Nogami

2016

Br J Haematol

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Thromboelastography (TEG) was first described by Hartert in 1948, and was designed to monitor viscoelastic clot strength in whole blood in real time. The current TEG method and Rotational Thromboelastometry (ROTEM) were subsequently developed from the original principles. Both of the modern methods provide data by measuring changes in the viscoelastic strength of a small sample of clotting blood in response to a constant rotational force. The important advantage of these techniques is to visually observe and quantify blood coagulation including the propagation, stabilization and dissolution phases of clot formation under low shear conditions. Analysis of the results provides detailed kinetic data on fibrin generation, clot strength and fibrinolysis. These TEG/ROTEM analyses therefore enable evaluation of global clotting function and the monitoring of haemostatic treatment in various clinical situations, not only in patients with genetic bleeding disorders, such as haemophilia, but also in patients undergoing cardiac surgery, liver transplantation or suffering from traumatic injury. Some evidence suggests that haemostatic management using TEG/ROTEM leads to a reduction in total transfusions of whole blood or clotting factors. Wider clinical application of this technology seems likely.

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Fresh and Citrated Whole-Blood Specimens Can Produce Different Thromboelastography Results in Patients on Extracorporeal Membrane Oxygenation

Abstract: In some patients on ECMO, use of samples collected in sodium citrate tubes for TEG analysis results in significant artifacts, which could lead to heparin overdosing in these patients.

Cited by 21 publications

References 10 publications

TEG and ROTEM: Technology and clinical applications

TEG and ROTEM: Technology and clinical applications

Management of the thrombotic risk associated with COVID-19: guidance for the hemostasis laboratory

The utility of thromboelastography in inherited and acquired bleeding disorders

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