Challenges in the laboratory analyses of bleeding disorders

Area of Science:

• Hematology
• Coagulation Science

Background:

• Standard coagulation assays (activated partial thromboplastin time, prothrombin time) detect specific factor deficiencies but may not fully capture clot formation dynamics.
• Deficiencies in factors VIII and IX are detectable by specific clotting assays, yet overall clot sufficiency requires a broader assessment.

Purpose of the Study:

• To review global hemostasis assays that provide a more complete picture of clot formation and lysis.
• To discuss the clinical relevance of these assays in evaluating bleeding disorders and the efficacy of bypassing agents in hemophilia.

Main Methods:

• Focus on thrombin generation assays, thromboelastography, activated partial thromboplastin time waveform analysis, and the clot formation and lysis (CloFAL) assay.
• These assays measure thrombin production and clot formation kinetics, offering insights into hemostasis and fibrinolysis.

Main Results:

• Global assays provide greater insight into hemostatic and fibrinolytic mechanisms compared to standard tests.
• These assays demonstrate clinical relevance in assessing treatment response to bypassing agents for acute bleeding in hemophilia.

Conclusions:

• Global hemostasis assays offer a more comprehensive assessment of bleeding disorders and thrombophilia than standard coagulation tests.
• The clinical utility of global assays in guiding treatment decisions, particularly with bypassing agents, is significant.