Reference ranges of thromboelastometry in healthy full-term and pre-term neonates

Sokou, Rozeta; Foudoulaki-Paparizos, Leontini E.; Lytras, Theodore; Konstantinidi, Aikaterini; Theodoraki, Martha; Lambadaridis, Ioannis; Gounaris, Antonios; Valsami, Serena; Politou, Marianna; Gialeraki, Argyri; Nikolopoulos, Georgios K.; Iacovidou, Nicoletta; Bonovas, Stefanos; Tsantes, Argirios Ε.

doi:10.1515/cclm-2016-0931

Cited by 41 publications

(38 citation statements)

References 13 publications

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“…With the increase in age, the Angle, MA and LY30 values increased and the K value decreased. Results showed that the younger the neonate is, the higher the risk of bleeding, and healthy newborns showed a positive correlation with the speed of starting coagulation, which was consistent with previous reports . In addition, the R value was more prolonged in newborns delivered by caesarean section, indicating a probable higher risk of bleeding by caesarean section.…”

Section: Discussionsupporting

confidence: 90%

“…Results showed that the younger the neonate is, the higher the risk of bleeding, and healthy newborns showed a positive correlation with the speed of starting coagulation, which was consistent with previous TA B L E 2 Comparing the differences in the reference ranges of TEG parameters determined in this study and provided by manufacturers in evaluating neonatal coagulation reports. 15,20,33 In addition, the R value was more prolonged in newborns delivered by caesarean section, indicating a probable higher risk of bleeding by caesarean section. According to the statistical results, we found that the R value was also related to gender, the R value was more prolonged in girls and they may be at higher risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Establishing a reference range for thromboelastograph parameters in the neonatal period

Qin

Chen

et al. 2019

Int J Lab Hematology

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IntroductionAcquired coagulation disorders are a common cause of neonatal bleeding. The thromboelastograph (TEG) comprehensively assesses haemostatic processes in the body. Unfortunately, the reference range of TEG parameters in the neonatal period has not yet been evaluated, which limits the use of the TEG in neonates. In this study, we aimed to establish the reference range of TEG parameters for the neonatal period.MethodsThis study included 371 full‐term infants (≥37 weeks of gestation), and we divided these infants into three groups according to age as follows: 1, 2‐7 and 8‐28 days. We measured their peripheral blood using TEG, coagulation routine and platelet count tests. We analysed differences among the groups.ResultsThe reference ranges for TEG parameters are presented as medians and reference ranges (2.5th and 97.5th percentiles) as follows: R (clot reaction time, seconds) 4.80 (2.80‐7.17), Angle (fibrin production rate) 69.90 (44.91‐78.89), K (clot kinetics, min) 1.40 (0.80‐4.50), MA (maximum amplitude, mm) 63.50(44.34‐74.66) and LY30 (lysis at 30 minutes, %) 0.10 (0.10‐6.95). There were significant differences in Angle, K, MA and LY30 values between the different neonatal day age groups.ConclusionThis study preliminarily establishes a reference range for TEG parameters during the neonatal period. The age of a newborn had a large influence on TEG parameters. Additionally, we demonstrated a correlation between laboratory tests and TEG parameters for this age period. The reference values provided herein are meaningful for future studies.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Establishing a reference range for thromboelastograph parameters in the neonatal period

Qin

Chen

et al. 2019

Int J Lab Hematology

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“…Therefore, clot firmness management, e.g., a reduced A5 FIB and A5 in EXTEM assay (A5 EX ), should precede thrombin generation management, e.g., a prolonged CT EX and CT in INTEM assay (CT IN ). ROTEM reference ranges have been established for several populations of healthy individuals (geographically, US and non- Algorithms for ROTEM-guided management US), neonates, infants, children, adolescents, and adults, as well as for pregnant women (1st-3rd trimester and peri-partum) [37][38][39][40][41][42]. However, the reference ranges describing the 95% prediction interval for a specific population of healthy individuals can be used for orientation only and are not designed to predict bleeding or transfusion requirements.…”

Section: Basic Concepts Of Poc Rotem-guided Blee Ding Management Algomentioning

confidence: 99%

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Görlinger

Pérez-Ferrer

Dirkmann

et al. 2019

Korean J Anesthesiol

147

132

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Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management ('theranostic' approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration. Fig. 1. ROTEM trace ('temogram') displaying the clinically most important parameters and their informative value. FDPs: fibrin (ogen) split products. Courtesy of Klaus Görlinger, Germany.

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“…In addition, studies attempting to establish normal reference ranges for POC tests have been small 5 and have suggested that differences exist between premature neonates and full-term neonates. 6 Additional experience and larger validation studies with these devices will allow increased comfort and improved utilization. Further trials are needed to determine the role and influence of both simple coagulation tests and POC coagulation tests in their ability to predict the risk of bleeding in children, management, and final outcome.…”

Section: Reply To: Use Of Rotem In Correction Of Unexpected Oozing Inmentioning

confidence: 99%

“…In addition, studies attempting to establish normal reference ranges for POC tests have been small and have suggested that differences exist between premature neonates and full‐term neonates . Additional experience and larger validation studies with these devices will allow increased comfort and improved utilization.…”

mentioning

confidence: 99%

Reply to: Use of ROTEM in correction of unexpected oozing in a child with a preexisting normal coagulation profile undergoing splenectomy

Lieberman

2018

Pediatric Blood & Cancer

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Reference ranges of thromboelastometry in healthy full-term and pre-term neonates

Cited by 41 publications

References 13 publications

Establishing a reference range for thromboelastograph parameters in the neonatal period

Establishing a reference range for thromboelastograph parameters in the neonatal period

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Reply to: Use of ROTEM in correction of unexpected oozing in a child with a preexisting normal coagulation profile undergoing splenectomy

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