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Celite-activated thrombelastography in children
E G Pivalizza1, P J Pivalizza, L I Gottschalk
1Department of Anesthesiology and School of Public Health, University of Texas Health Science Center-Houston, Houston, TX 77030, USA. Evan.G.Pivalizza@uth.tmc.edu
Insights
This study established normal ranges for the celite-activated thrombelastograph (TEG) in children, finding minor coagulation differences compared to adults that do not indicate abnormal function.
Area of Science:
- Pediatric Coagulation
- Hemostasis Monitoring
- Thrombelastography
Background:
- Establishing normal hemostasis ranges in pediatric populations is crucial for accurate clinical interpretation.
- The celite-activated thrombelastograph (TEG) is a valuable tool for assessing global coagulation.
- Limited data exists on age-specific normal TEG values in healthy children.
Purpose of the Study:
- To quantify global coagulation using the celite-activated TEG.
- To establish normal reference ranges for celite-activated TEG parameters in healthy pediatric patients across different age groups.
- To compare pediatric TEG values with those of healthy adults.
Main Methods:
- A prospective observational study was conducted in a university hospital setting.
- 110 healthy pediatric patients (categorized into four age groups) and 25 healthy adults were enrolled.
- Blood samples were analyzed using celite-activated TEG after anesthetic induction, measuring R time, K time, alpha angle, maximum amplitude, TEG index, and percent fibrinolysis.
Main Results:
- Statistically significant differences were observed in alpha angle and percent fibrinolysis between certain pediatric age groups.
- Significant differences in angle and TEG index were found when comparing pediatric groups to the adult group (p < 0.05).
- These observed changes were of small magnitude and not consistently age-related.
Conclusions:
- The study identified minor variations in celite-TEG parameters in healthy children compared to adults.
- These differences do not suggest abnormal coagulation between the pediatric and adult groups.
- The established normal ranges will aid clinicians in monitoring coagulation status in pediatric patients.
Study Objective:
To quantify global coagulation and establish normal ranges for the celite-activated thrombelastograph (TEG) in healthy pediatric patients.
Design:
Prospective observational study.
Setting:
Operating suite of a university-based hospital.
Patients:
110 healthy pediatric patients in four age groups and 25 healthy adult patients.
Interventions:
Blood sampling for the celite-activated TEG was carried out after anesthetic induction.
Measurements:
TEG indices: R time (reflecting time to fibrin formation), K time and alpha angle (fibrinogen-platelet interaction), maximum amplitude (reflecting maximal clot strength, platelet and fibrinogen function), TEG index (mathematical incorporation of the prior four measurements), and percent fibrinolysis at 30 minutes, were all recorded.
Main Results:
Statistically significant differences between <12-month group in angle (compared to 25-48 month group) and % fibrinolysis (compared to all other pediatric groups). Significant differences in angle between two pediatric groups and adult group, and in the TEG index between three pediatric groups and adult group (all differences p < 0.05).
Conclusions:
These data identify changes of small magnitude in three celite-TEG parameters in healthy children compared to adults, without implication of abnormal coagulation between groups. Changes do not seem to be consistently related to age and will be useful for clinicians using the TEG to monitor (ab) normal coagulation in pediatric patients.