title: Thromboelastography (TEG®) compared with total platelet count in thrombocytopenia haematological malignancy patients with bleeding: a pilot observational study.
abstract: BACKGROUND
  There has been no reported use of Thromboelastography(®) (TEG(®) ) in assessing thrombocytopenic haematological malignancy (HM) patients experiencing bleeding.
  
  
  OBJECTIVE
  To assess whether there are differences in TEG(®) variables in thrombocytopenic HM patients experiencing clinically significant bleeding compared with those not experiencing bleeding.
  
  
  METHODS
  Thirty adult patients with HM and a total platelet count (TPC) of ≤ 30 × 10(9) L(-1) were observed for greater than or equal to grade two World Health Organisation (WHO) bleeding episodes for 72 h. They had TPC, TEG(®) parameters [maximal amplitude (MA), reaction time (R-time), alpha (α-angle) and functional fibrinogen (FF) levels], activated partial thromboplastin time (APTT) and prothrombin time (PT) measured at inclusion, 24 and 48 h.
  
  
  RESULTS
  Five patients had nine significant bleeding episodes. Patients bleeding (n) were all more hypocoaguable when measured by TEG(®) than patients not bleeding at inclusion n = 4 (MA: 16.9 vs 31.8 mm, P < 0.01; R-time: 10.1 vs 7.5 min, P = 0.02; α-angle: 18.8 vs 28.4, P < 0.01; FF: 182.4 vs 204 mg dL(-1), P < 0.01), at 24 h n = 3 (MA 18 vs 29.4 mm, P = 0.02; R-time: 9.4 vs 7.4 mins, P = 0.02; α-angle: 21.6 vs 26.5, P = 0.04 and FF: 168 vs 201 mg dL(-1) P = 0.01) and at 48 h n = 2 (MA: 29.7 vs 23.0, P = 0.02; R-time: 8.1 vs 6.7 mins, P = 0.05; α-angle: 22.6 vs 26.5, P = 0.04; FF: 170 vs 208 mg dL(-1), P = 0.01). There were no significant differences in TPC, APTT or PT between patients that bled and those that did not at each time point.
  
  
  CONCLUSIONS
  Thrombocytopenic HM patients experiencing bleeding are hypocoaguable on TEG(®).
authors.affiliation: Department of Anaesthesia and Perioperative Care, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Kasivisvanathan
authors.affiliation: Department of Anaesthesia and Perioperative Care, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Koutra
authors.affiliation: Department of Anaesthesia and Perioperative Care, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Rooms
authors.affiliation: Department of Research and Development, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Black
authors.affiliation: Transfusion Laboratory, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Desai
authors.affiliation: Department of Anaesthesia and Perioperative Care, The Royal Free NHS Foundation Trust, London, UK.
authors.forename: S V
authors.initials: SV
authors.lastname: Mallett
authors.affiliation: Department of Anaesthesia and Perioperative Care, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Rao-Baikady
mesh_terms: D000328:Adult; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood*; D006470:Hemorrhage / Q000097:blood*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D010976:Platelet Count; D011446:Prospective Studies; D013916:Thrombelastography
keywords: haematological malignancy; platelet function monitoring; platelet transfusion; point of care coagulation; transfusion practice