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Updated: Dec 31, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
TEG Platelet Mapping and Impedance Aggregometry to Predict Platelet Transfusion During Cardiopulmonary Bypass in
Erin E Barker1,2, Arun Saini3, Avihu Z Gazit2
1Division of Pediatric Critical Care, University of Rochester, Rochester, NY, United States.
Insights
Thromboelastography with platelet mapping (TEG-PM) at the ADP receptor may help predict platelet transfusions in pediatric cardiac surgery patients. However, limited correlation between TEG-PM and MEIA tests raises concerns about accuracy.
Area of Science:
- Cardiology
- Hematology
- Pediatric Surgery
Background:
- Cardiopulmonary bypass (CPB) can cause platelet dysfunction, increasing bleeding risk in pediatric cardiac surgery.
- Accurate tests identifying platelet abnormalities are needed to guide transfusions and reduce bleeding.
- Thromboelastography with platelet mapping (TEG-PM) and multiple electrode impedance aggregometry (MEIA) are functional platelet tests.
Purpose of the Study:
- To evaluate if TEG-PM and MEIA can predict the need for platelet transfusions in children undergoing CPB.
- To assess the correlation between TEG-PM and MEIA results for arachidonic acid (AA) and adenosine diphosphate (ADP) receptors.
Main Methods:
- Prospective study of 44 children (newborn to 5 years) with congenital heart disease undergoing CPB.
- Blood samples analyzed using TEG-PM and MEIA at four time points: pre-bypass, post-bypass, post-operative, and 24h post-operative.
- Analysis focused on predicting peri-operative platelet transfusion.
Main Results:
- Ten patients received peri-operative platelet transfusions; they were younger, had higher STAT Mortality Categories, and longer CPB times.
- TEG-PM ADP showed moderate predictive value (AUC 0.745) for platelet transfusion, with a threshold of ≤21 offering 85% sensitivity and 70% specificity.
- TEG-PM and MEIA correlated for AA receptors but not for ADP receptors, suggesting potential accuracy concerns at the ADP receptor.
Conclusions:
- TEG-PM ADP may offer more relevant clinical information than MEIA at the ADP receptor in pediatric CPB patients.
- Limited correlation between TEG-PM and MEIA at the ADP receptor warrants further investigation.
- Lower pre-operative TEG-PM ADP may predict the need for intra-operative platelet transfusions, but larger studies are needed.
Abstract:
Background: Cardiopulmonary bypass-related platelet dysfunction can increase the risk of intra- and post-operative bleeding in children undergoing cardiac surgery. More accurate laboratory tests that identify acquired platelet abnormalities could allow for rapid identification of patients at risk of bleeding and provide therapies that could reduce bleeding and platelet transfusions. We hypothesized that thromboelastography with platelet mapping (TEG-PM) and multiple electrode impedance aggregometry (MEIA) as functional measures of platelet function would predict who will require platelet transfusion. Our secondary hypothesis was that platelet aggregation at both arachidonic acid (AA) and adenosine diphosphate (ADP) receptors would correlate between TEG-PM and MEIA results. Methods: In this prospective study from August 2013 to December 2015, children from newborn to 5 years of age with congenital heart disease undergoing cardiopulmonary bypass had blood samples collected and analyzed at four time points: pre-bypass, post-bypass, post-operatively on arrival to the Cardiac Intensive Care Unit, and 24 h after arrival. Results: Of the 44 patients analyzed, the 10 patients who received peri-operative platelet transfusion were significantly younger (p = 0.05), had higher STAT (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery) Mortality Categories (p < 0.002) and longer cardiopulmonary bypass times (p = 0.02). In univariate analysis, four variables were associated with peri-operative platelet transfusion: pre-operative age [OR 0.95 (0.93, 0.98), p = 0.03], cardiopulmonary bypass time [1.5 (1.31, 1.68), p = 0.008], STAT Mortality Category [3.64 (3.40, 3.87), p < 0.001], and TEG-PM ADP [0.79 (0.65, 0.93), p = 0.04]. ROC analysis demonstrated moderate predictive value of TEG-PM ADP with AUC of 0.745 (0.59, 0.91). A TEG-PM ADP value of less than or equal to 21 had 85% sensitivity and 70% specificity for platelet transfusion. In the multivariate analysis, only STAT Mortality Category predicted platelet transfusion. TEG-PM and MEIA results correlated for the AA receptor at all 4 time points, but the same tests at the ADP receptors did not correlate. Conclusions: TEG-PM ADP may provide more clinically relevant information regarding platelet function compared to the MEIA at the ADP receptor in children requiring cardiopulmonary bypass. There was limited correlation between TEG-PM and MEIA results which raises a concern about the accuracy of these tests at the ADP receptor. Lower pre-operative TEG-PM ADP MA may predict intra-operative platelet transfusions; however, larger studies are needed to determine the utility of TEG-PM and MEIA in guiding platelet transfusions in this population.
