Use of point‐of‐care testing for plasma therapy

Abstract

Use of point-of-care testing (POCT) has been driven by limitations of laboratory-based testing as a tool for decisions for transfusions of blood components. Clinical settings such as liver transplantation, cardiothoracic surgery, and trauma are particularly in need of such diagnostic tests because of the complex coagulopathies that can develop in these settings of substantial hemorrhage and need for blood component support. Successful implementation of POCT requires collaboration between surgery, anesthesia, critical care, and the laboratory to ensure proper quality control of equipment, operator training and competency, medical records test results, billing procedures, and consensus-derived transfusion algorithms for cost-effective, targeted blood component transfusion support. In this review we summarize clinical evidence for the effectiveness of POCT, along with some future directions for this strategy.U se of point-of-care testing (POCT) has been driven by limitations of laboratory-based testing as a decision-guiding tool for blood component therapy, particularly in patients with substantial hemorrhage or complex coagulopathy. Thromboelastography (TEG) was first developed in 1948 and is a global assay of coagulation that uses whole blood to produce a tracing that records kinetic changes in clot formation. This tracing allows the rapid assessment of coagulation and fibrinolysis that is dependent on the interaction of the coagulation factors, platelets (PLTs), and fibrinogen.1 It has been tested and is now widely used in various clinical scenarios such as cardiac surgery, 2 hepatic transplantation, 3 and major trauma (with concomitant massive transfusion therapy) 4 to monitor and guide blood component therapy. Newer POCT technologies have also become available that provide rapid hemostasis results with whole blood. The accuracy and reliability of the POCT for prothrombin time (PT), activated partial thromboplastin time (aPTT), and PLT assays have been demonstrated. 5,6 POCT systems are being developed to impact use of blood component therapy utilizing two variables: timely availability of assay results and their link to algorithms for result-based use of blood component therapy. 2,7,8 This review will summarize the use of these strategies as currently applied, along with potential future applications. COAGULOPATHY IN SURGICAL SETTINGSThe complex coagulopathy in patients undergoing liver transplant, along with the role of point-of-care monitoring in this setting, have been well established 3 and will therefore not be discussed further in this review. Cardiopulmonary bypassExposure of blood to an extracorporeal circuit results in abnormalities of the hemostatic system, which can lead to excessive bleeding; 9 the type of cardiac procedure and the duration of cardiopulmonary bypass (CPB) influence the risk for development of coagulopathic bleeding, 10 and the volumes of cardiac surgery procedures along with substantial number of blood components transfused in these patients, have made this clinical setting an impo...

Central Laboratory Service and Point-of-Care Testing in Germany—From Conflicting Notions to Complementary Understandings

“…66,67 These subjects are particularly in need of coagulation tests because of the complex coagulopathies that can develop from substantial hemorrhage. Effective implementation of the viscoelastic technology, such as thrombelastography or rotational thromboelastometry, had significant effects on the amount of administered freshfrozen plasma, as well as erythrocyte and thrombocyte concentrates in massively transfused patients.…”

Coagulation monitoring devices: Past, present, and future at the point of care

“…Goodnough & Hill [19] have highlighted the need for POC coagulation testing in clinical settings including liver transplantation, cardiothoracic surgery, and trauma because of the high risk of hemorrhage and the resulting requirements for blood component support. Other research has identified that POC testing in the form of platelet count, PT, aPTT and fibrinogen concentration has resulted in reduced blood loss, shorter surgical times, and reduced transfusion requirements [20,21].…”

Point of Care Testing and Transfusion Safety in Resource Limited Settings: A Review

“…Their main uses are the monitoring of vitamin-K antagonist oral anticoagulants, the assessment of platelet function, in particular in patients undergoing anti-platelets therapy, as well as the rapid evaluation of clotting function in bleeding patients during surgery and in emergency settings [33][34][35][36][37]. Out of these the viscoelastometric POCT devices are particularly useful in giving quick information on all the main phases and components of clot formation, including fibrinogen concentration, platelet activity and fibrinolysis [38].…”