Does rotational thromboelastometry accurately predict coagulation status in patients with lupus anticoagulant?

Area of Science:

• Hematology
• Clinical Chemistry

Background:

• Rotational thromboelastometry (ROTEM) is a valuable tool for assessing coagulation.
• Certain coagulation abnormalities, like lupus anticoagulant (LA), can complicate ROTEM interpretation.

Purpose of the Study:

• To investigate the impact of lupus anticoagulant (LA) on rotational thromboelastometry (ROTEM) results.
• To determine if LA causes abnormalities in ROTEM clotting time (CT).

Main Methods:

• Prospective observational analysis of 16 children with suspected LA or antiphospholipid antibodies.
• ROTEM analysis performed with and without added phospholipids (PL).
• Standard coagulation tests including PT, APTT, DRVVT, and hexagonal phase phospholipid neutralization test.

Main Results:

• Eleven of eighteen samples showed prolonged CT in INTEM and EXTEM ROTEM assays.
• Prolonged CT correlated with high DRVVT ratios and prolonged APTT.
• Addition of PL partially reversed CT prolongation, indicating PL-dependent inhibition.

Conclusions:

• Strongly positive lupus anticoagulant (LA) can significantly prolong ROTEM clotting time (CT).
• This prolongation can lead to erroneous conclusions about a patient's coagulation status.
• LA-induced CT prolongation is a phospholipid-dependent phenomenon.