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Pediatric Thromboelastograph 6s and Laboratory Coagulation Reference Values

Katie M Moynihan1,2,3,4, Kerry Johnson3,5, Mark Rane6

  • 1From the Department of Cardiology, Division of Cardiovascular Critical Care, Boston Children's Hospital, Massachusetts (Moynihan).

Archives of Pathology & Laboratory Medicine
|January 27, 2021
PubMed

Insights

This study established new pediatric reference intervals (RIs) for Thromboelastograph 6s (TEG 6s) and coagulation tests. These age-specific RIs improve the accuracy of interpreting pediatric coagulation results.

Area of Science:

  • Pediatric Coagulation Science
  • Clinical Pathology
  • Hemostasis Analysis

Background:

  • Accurate interpretation of coagulation tests relies on specific reference intervals (RIs).
  • Current TEG 6s RIs are based on adult samples, potentially leading to inaccuracies in pediatric patients.
  • Coagulation assay results can differ based on patient demographics, reagents, and analyzers.

Purpose of the Study:

  • To establish reagent and analyzer-specific pediatric RIs for the TEG 6s Hemostasis Analyzer.
  • To develop pediatric RIs for key coagulation parameters.
  • To address the lack of age-specific reference ranges in pediatric hemostasis testing.

Main Methods:

  • Prospective observational study of 254 healthy children undergoing general anesthesia.
  • Collected venous blood samples for TEG 6s assays (Kaolin, Kaolin-Heparinase, Rapid, Functional Fibrinogen) and standard coagulation tests (aPTT, PT, TT, Echis, Antithrombin, Fibrinogen).
  • Generated pediatric RIs using discrete age groups and model-based quantile regression, analyzing age and sex influences.

Main Results:

  • Clinically significant variations were observed between different reagents for prothrombin time (PT) and activated partial thromboplastin time (aPTT) assays.
  • Reagent and analyzer-specific pediatric RIs were successfully generated for TEG 6s and coagulation parameters using data from 254 children.
  • Both discrete and model-based RIs demonstrated age-dependent variations across all tested coagulation parameters and TEG 6s variables.

Conclusions:

  • This study reports the first reagent-analyzer specific pediatric RIs for TEG 6s and coagulation parameters.
  • The observed variations underscore the necessity for laboratory-specific RIs, particularly in pediatric populations.
  • The developed RIs enhance the accuracy of clinical result interpretation and highlight the advantages of model-based RI approaches.
Abstract

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