Ann Lab Med.  2024 Jan;44(1):74-81. 10.3343/alm.2024.44.1.74.

Prediction of Mid-term Platelet Transfusion in Stable Trauma Patients Using Rotational Thromboelastometry

• Lim HJ
• Jang H
• Lee N
• Jeong E
• Park Y
• Jo Y
• Kim J
• Lee YE
• Choi HJ
• Kee SJ
• Shin JH
• Shin MG

• KMID: 2550225
• DOI: http://doi.org/10.3343/alm.2024.44.1.74

Abstract

Background
Rotational thromboelastometry (ROTEM; TEM International GmbH, Munich, Germany) is a global coagulation test that guides evidence-based platelet transfusion in trauma patients. We evaluated ROTEM parameters for predicting mid-term (five days) platelet transfusion in trauma patients.
Methods
Maximum clot firmness and clot amplitudes after 5, 10, and 15 mins (A5, A10, and A15, respectively) of fibrin-specific ROTEM (FIBTEM) and extrinsically activated ROTEM (EXTEM) were retrospectively collected from 82 hospitalized, stable, non-bleeding trauma patients after successful initial resuscitation. Platelet-specific ROTEM (PLTEM) was calculated by subtracting FIBTEM from EXTEM. Platelet transfusions were reviewed for five days after ROTEM.
Results
The areas under the curve for FIBTEM, EXTEM, and PLTEM predicting platelet concentrate transfusion of > 12 U at mid-term were 0.915–0.923, 0.878–0.896, and 0.551–0.735, respectively. FIBTEM and EXTEM parameters were comparable to those of fibrinogen, fibrin/fibrinogen degradation products, D-dimer, and antithrombin III. Strong correlations (r > 0.7) were noted between platelet count and EXTEM (A5, A10, and A15) or PLTEM (A5), platelet function (per platelet count) and EXTEM (A10 and A15), and fibrinogen levels and all FIBTEM parameters.
Conclusions
FIBTEM and EXTEM can reliably predict mid-term platelet transfusion in trauma patients. FIBTEM, EXTEM, and PLTEM parameters correlate with conventional coagulation tests (platelets and fibrinogen).

Keyword

Fibrinogen; Platelets; Platelet transfusion; Rotational thromboelastometry; Trauma

Figure

• 

  Fig. 1 Data collection of clinical information, laboratory results, and transfusion requirements in this study. Abbreviations: DIC, disseminated intravascular coagulation; PFA-100, Platelet Function Analyzer-100; PT, prothrombin time; aPTT, activated partial thromboplastin time; FDPs, fibrin/fibrinogen degradation products; ROTEM, rotational thromboelastometry; EXTEM, extrinsically activated ROTEM; FIBTEM, fibrin-specific ROTEM; D0, day 0; D1, day 1; D5, day 5; PCs, platelet concentrates.

• 

  Fig. 2 Prediction of mid-term platelet transfusion. (A) EXTEM parameters, (B) FIBTEM parameters, (C) PLTEM parameters, and (D) conventional coagulation tests. Abbreviations: AUC, area under the curve. See Table 1 for definitions of the abbreviations related to the ROTEM and conventional coagulation tests.

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