Thrombocytopenia affects plasmatic coagulation as measured by thrombelastography

Roeloffzen, Wilfried; Kluin-Nelemans, Hanneke C.; Mulder, André B.; Wolf, Jtm de

doi:10.1097/mbc.0b013e328335d0e4

Cited by 31 publications

(31 citation statements)

References 23 publications

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“…Therefore, α ° may be primarily dependent upon fibrin(ogen) but may also indicate thrombocytopenia. 124 Consistent with this, platelet count correlates strongly with α °, 125 and platelet transfusion elevates α ° during PPH. 94 …”

Section: Teg® and Rotem®; Intraoperative Assessment And Haemostatic Tsupporting

confidence: 54%

Haemostatic monitoring during postpartum haemorrhage and implications for management

Solomon

Collis

Collins

2012

British Journal of Anaesthesia

187

162

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SummaryPostpartum haemorrhage (PPH) is a major risk factor for maternal morbidity and mortality. PPH has numerous causative factors, which makes its occurrence and severity difficult to predict. Underlying haemostatic imbalances such as consumptive and dilutional coagulopathies may develop during PPH, and can exacerbate bleeding and lead to progression to severe PPH. Monitoring coagulation status in patients with PPH may be crucial for effective haemostatic management, goal-directed therapy, and improved outcomes. However, current PPH management guidelines do not account for the altered baseline coagulation status observed in pregnant patients, and the appropriate transfusion triggers to use in PPH are unknown, due to a lack of high-quality studies specific to this area. In this review, we consider the evidence for the use of standard laboratory-based coagulation tests and point-of-care viscoelastic coagulation monitoring in PPH. Many laboratory-based tests are unsuitable for emergency use due to their long turnaround times, so have limited value for the management of PPH. Emerging evidence suggests that viscoelastic monitoring, using thrombelastography- or thromboelastometry-based tests, may be useful for rapid assessment and for guiding haemostatic therapy during PPH. However, further studies are needed to define the ranges of reference values that should be considered ‘normal’ in this setting. Improving awareness of the correct application and interpretation of viscoelastic coagulation monitoring techniques may be critical in realizing their emergency diagnostic potential.

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Section: Teg® and Rotem®; Intraoperative Assessment And Haemostatic Tsupporting

confidence: 54%

Haemostatic monitoring during postpartum haemorrhage and implications for management

Solomon

Collis

Collins

2012

British Journal of Anaesthesia

187

162

View full text Add to dashboard Cite

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“…In this subgroup, their MA is actually markedly higher compared to normal controls (62.7 vs 57.8 mm, P < 0.001), with patients with mild thrombocytopenia having the highest MA (mean 66.4 mm). These results were similar to a study by Roeloffzen et al which observed a trend, albeit a non‐significant one, towards more hypercoagulable TEG ® parameters in patients with platelets ≧100 × 10 9 /L on consolidation chemotherapy. Hypercoagulable parameters are also seen with fibrin generation with increased OHP levels.…”

Section: Discussionsupporting

confidence: 91%

“…Previous clinical studies have demonstrated hypocoagulable parameters (particularly reduced maximum amplitude) in patients with severe thrombocytopenia despite no significant differences in PT and APTT, which is similar to our TEG ® experience. However, the data for thrombin generation are less clear with Álvarez‐Román et al observing an elevated ETP (1696.4 vs 1223.8, P < 0.05) in 42 chronic ITP patients with platelet count <50 × 10 9 /L, in contrast to our ITP patients with marked thrombocytopenia.…”

Section: Discussionsupporting

confidence: 89%

A comparison of global coagulation assays between normal controls and patients with thrombocytopenia

Lim

Leung

Manitta

et al. 2018

Int J Lab Hematology

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Introduction Some patients with thrombocytopenia may be at risk of bleeding although quantitative platelet count is not always a sufficient predictive factor. Global coagulation assays such as thromboelastography (TEG®), calibrated automated thrombogram (CAT) and overall haemostatic potential (OHP) may provide a better assessment of an individual's haemostatic profile. Methods Blood samples were collected from thrombocytopenic patients. TEG® was performed on citrated whole blood, while CAT and OHP were performed on platelet‐poor plasma. Results were compared to our previously collected normal controls. Results Fifty‐eight participants (24 immune thrombocytopenia, 34 chemotherapy/malignancy‐related) with mean age of 57.5 years were recruited. Compared to normal controls, thrombocytopenic participants had comparable maximum amplitude but reduced clot lysis (0.0% vs 0.6%; P < 0.001) on TEG® with reduced endogenous thrombin potential on CAT (1252.2 vs 1353.0 nmol/L/min; P = 0.040). No differences were seen in the OHP parameters. TEG® showed significant difference between marked and mild thrombocytopenia groups with minimal differences seen on CAT and OHP. Those with marked thrombocytopenia showed reduced maximum amplitude (47.2 vs 57.8 mm; P = 0.002) as expected while participants with mild thrombocytopenia (platelet count 100‐150 × 109/L) paradoxically demonstrated increased maximum amplitude (66.4 vs 57.8 mm; P < 0.001). Conclusion Global coagulation assays, particularly TEG®, can detect subtle differences in coagulation in thrombocytopenic patients. While patients with marked thrombocytopenia showed reduced maximum amplitude, patients with mild thrombocytopenia appear to paradoxically show increased maximum amplitude, suggesting compensatory activity within the coagulation pathway which may in part explain why not all thrombocytopenic patients have bleeding complications.

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“…In FXIII deficiency, kTEG is expected to show decreased MA and increased K, corresponding with our observation as well . While thrombocytopenia can also result in kTEG abnormalities, including decreased MA, we observed these abnormalities regardless of PLT count, which ranged from 64 × 10 9 to 80 × 10 9 /L at the time of the initial kTEG screening, which would not be expected to result in the severe abnormalities observed in this patient . We gave 7 units of cryoprecipitate as treatment (each unit of cryoprecipitate contains 50‐75 units of FXIII) and sent testing for FXIII inhibitors.…”

Section: Case Reportsupporting

confidence: 81%

Treatment of an acquired Factor XIII inhibitor in an adolescent with systemic lupus erythematosus and renal failure

et al. 2017

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Thrombocytopenia affects plasmatic coagulation as measured by thrombelastography

Cited by 31 publications

References 23 publications

Haemostatic monitoring during postpartum haemorrhage and implications for management

Haemostatic monitoring during postpartum haemorrhage and implications for management

A comparison of global coagulation assays between normal controls and patients with thrombocytopenia

Treatment of an acquired Factor XIII inhibitor in an adolescent with systemic lupus erythematosus and renal failure

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