Thromboelastography may predict risk of grade 2 bleeding in thrombocytopenic patients

Platelet count is used as a prophylactic platelet transfusion trigger, although evidence suggests that it is a poor predictor of bleeding. Thus, alternative tests are required. The primary objective of this study was to compare thromboelastography (TEG) parameters on days with and without bleeding symptoms. The secondary objectives were to investigate the relationship between TEG parameters and haematological variables, fever, C-reactive protein (CRP) and platelet transfusion.

This is a prospective, observational pilot study of 13 thrombocytopenic, haemato-oncologic patients, over 17 cycles of chemotherapy. Bleeding assessment was performed daily together with a total platelet count (TPC), reticulated platelet per cent (RPP) and count (RPC), haemoglobin, mean platelet volume, white blood cell count (WBC), CRP and temperature. TEG analyses were performed on weekdays.

TEG alpha angle was significantly lower on days with World Health Organization (WHO) grade 2 bleeding than on days without bleeding. Haematologic variables, CRP and platelet transfusion the previous day were associated with the outcome of TEG analysis, but fever was not.

We found a highly significant correlation between the TEG alpha angle and WHO grade 2 bleeding. This finding suggests that fibrinogen-platelet interactions may affect the bleeding risk in thrombocytopenic patients.