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Thromboelastometry (ROTEM) in children: age-related reference ranges and correlations with standard coagulation

E Oswald1, B Stalzer, E Heitz

  • 1Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.

British Journal of Anaesthesia
|October 2, 2010
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Rotational thromboelastometry (ROTEM) provides rapid coagulation monitoring in children, establishing age-dependent reference ranges. Findings reveal accelerated coagulation initiation and propagation in infants, despite prolonged standard tests.

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Area of Science:

  • Pediatric Anesthesiology
  • Hemostasis and Thrombosis Research
  • Clinical Coagulation Diagnostics

Background:

  • Viscoelastic methods like rotational thromboelastometry (ROTEM) are valuable for pediatric coagulation monitoring due to small sample requirements and rapid results.
  • However, established reference ranges for ROTEM parameters in pediatric populations are limited.

Purpose of the Study:

  • To establish age-dependent reference ranges for ROTEM assays in children undergoing elective surgery.
  • To analyze the age-related dependency of ROTEM parameters.
  • To compare ROTEM data with conventional coagulation tests.

Main Methods:

  • Prospective, two-center observational study involving 407 children (ASA I and II) undergoing elective surgery.
  • Children were stratified into six age groups: 0-3 months, 4-12 months, 13-24 months, 2-5 years, 6-10 years, and 11-16 years.
  • ROTEM assays were performed, and data were compared with standard coagulation tests.

Main Results:

  • Analysis included 359 children; ROTEM parameters showed significant age-dependent differences, except for clot strength and lysis.
  • Infants (0-3 months) demonstrated accelerated coagulation initiation and propagation (e.g., shorter ExTEM CT, higher α angle) compared to older children.
  • Despite accelerated ROTEM findings, standard coagulation tests (PT, aPTT) were prolonged in infants; lysis indices <85% were common without increased bleeding.

Conclusions:

  • Age-dependent reference ranges for ROTEM assays in pediatric patients were successfully established.
  • These new reference ranges are crucial for accurate interpretation of perioperative coagulation status in children.
  • The findings highlight distinct hemostatic profiles in infants compared to older children and standard tests.