Peculiar whole blood rotation thromboelastometry (Rotem) profile in 40 sideropenic anaemia patients

Abstract

The ROtation ThromboElastoMetry analyser (ROTEM, Pentapharm, Munich, Germany) is useful for studying whole blood (WB) clot formation and lysis. Reduction of haematocrit (HCT) has been reported to influence traditional thromboelastography parameters without compromising "in vitro" blood coagulation. We performed this case-control study to evaluate ROTEM profiles in sideropenic anaemia patients with different degrees of reduction of HCT levels. Forty consecutively referred patients with sideropenic anaemia were enrolled. A group of 40 healthy age and gender matched subjects acted as a control. The influence of HCT on ROTEM was assessed in the study population and in a model of artificially reconstituted blood with modified HCT values. Cases presented significantly increased levels of maximum clot firmness (MCF) as compared to controls (p < 0.001) mimicking a sort of "hypercoagulable profile". However, thrombin generation tests failed to detect an increase in thrombin generation in cases as compared to controls. A statistically significant inverse linear correlation between HCT and MCF (p < 0.0001) was found. In addition, ROTEM profiles following "in vitro" manipulation of HCT confirmed the inverse linear correlation between HCT and MCF found in the study population. In conclusion, the increased clot firmness found by ROTEM in anaemic patients is likely to be related to the method in itself rather than representing a marker of hypercoagulability "in vivo". Since ROTEM is widely used by anaesthesiologists when deciding the optimisation of products supplementation during surgery, attention should be paid in the case of anaemic patients taking depending on the peculiar thrombo-elastography profile found.

Factor XIII Deficiency and Thrombocytopenia Are Frequent Modulators of Postoperative Clot Firmness in a Surgical Intensive Care Unit

“…Earlier research has shown that anemia is associated with increased (thrombelastometrically measured) clot firmness [45][46][47]. Thus, our finding is in line with these resultsbut also novel as our study demonstrates for the first time and in a multivariate analysis that the analogy, i.e., that lower clot firmness is associated with higher hemoglobin concentration, is also true.…”

Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery

“…Two BD vacutainer tubes (Becton-Dickinson, Franklin Lakes, New Jersey) containing sodium citrate 109 mmol/L (3.8 % sodium citrate) and one BD vacutainer tube containing ethylenediaminetetraacetic acid 5.4 mg (EDTA) were collected from each participant for each time interval. For each test considered in the study, normal values were those obtained in a group of 40 healthy volunteers matched with cases for gender and age (±3 years), randomly selected from our database and in part previously published [17]. Hemoglobin levels, platelet count and traditional coagulative parameters (i.e., PT/INR, aPTT, fibrinogen and antithrombin) were performed according to the standard procedures.…”

Pathophysiology and Treatment of Coagulopathy in Massive Hemorrhage and Hemodilution

“…Given some differences, both assays are particularly useful for the evaluation of fibrinogen deficiency, factor XIII deficiency, hemophilia, and fibrinolytic state. 11,30,[87][88][89] In patients with major trauma, early diagnosis and treatment of coagulopathy may be feasible using ROTEM-guided (goal-directed) hemostatic therapy ( fig. 5).…”

“…100 However, this finding has been questioned 101 and may reflect in vitro effects of decreased hematocrit. 89,102,103 Transfusion of erythrocytes is performed to improve oxygen carrying capacity, but increased hematocrit may also be beneficial for hemostasis. In the arterial vessel, platelets are preferentially distributed near the vessel wall (margination) because of the red cell mass.…”

“…103 In contrast, thromboelastometric measurement in anemic patients (mean hematocrit 28%) showed that angle and maximal clot firmness values were increased by 5°and 10 mm, respectively, compared with normal subjects (hematocrit 41%). 89 However, thromboelastometric measurements are conducted under low shear rates (0.1/s), and the red cell mass is "in the way" of spreading fibrin strands and their interaction with platelets glycoprotein IIb/IIIa.…”