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Establishing Pediatric Reference Ranges for Rotational Thromboelastometry
Erin Kathleen Goodhue Meyer1, Joshua Uffman2, Stephanie Townsend1
1Department of Pathology and Lab Medicine, Transfusion Service, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
This study established normal pediatric reference intervals for rotational thromboelastometry (ROTEM) Delta assays in children. These new age-specific ranges aid clinicians in making informed transfusion decisions for pediatric patients.
Area of Science:
- Pediatric Hematology
- Hemostasis and Thrombosis
- Clinical Pathology
Background:
- Accurate interpretation of rotational thromboelastometry (ROTEM) Delta assays in children requires age-specific reference intervals.
- Existing reference ranges are often based on adult data, potentially leading to misinterpretation in pediatric populations.
Purpose of the Study:
- To establish normal pediatric reference intervals (PRIs) for ROTEM Delta assays (EXTEM, INTEM, FIBTEM).
- To cover a wide pediatric age range from 0 to 18 years.
- To facilitate accurate interpretation of coagulation status in children.
Main Methods:
- Prospective study involving healthy pediatric patients undergoing elective minor surgery.
- Sampled 20 patients per sex across 5 age groups (0-6 months, 6-12 months, 1-5 years, 5-11 years, 11-18 years).
- ROTEM Delta assays (EXTEM, INTEM, FIBTEM) were performed.
Main Results:
- Two sets of ROTEM PRIs were defined: one for children 11 years or younger and another for those older than 11 years.
- PRIs for younger children were derived from the 2.5th and 97.5th percentiles of the 0-11 age groups.
- Adult reference intervals were validated for children older than 11 years.
Conclusions:
- Established age-specific ROTEM PRIs for pediatric patients.
- Integrated these PRIs into the electronic medical record for clinical use.
- Improved interpretation of ROTEM results and informed transfusion decisions in children.
Objectives:
The aim of our investigation was to establish normal pediatric reference intervals (PRIs) for rotational thromboelastometry (ROTEM) Delta assays in a representative group of healthy children, 0 to 18 years of age, at our institution.
Methods:
This was a prospective study of healthy pediatric patients undergoing elective minor surgery requiring placement of an intravenous cannula. The sample size for patients was 20 per age group of either sex from 5 different age groups based on coagulation system maturity: 0 to 6 or fewer months, more than 6 to 12 or fewer months, more than 1 year to 5 or fewer years, more than 5 to 11 or fewer years, and more than 11 to 18 or fewer years. ROTEM Delta assays assessed include the EXTEM, INTEM, and FIBTEM.
Results:
We defined 2 sets of ROTEM PRIs for our patient population: one for patients 11 years or younger and one for children more than 11 years of age. For those 11 years or younger, the PRIs were derived from the 2.5th and 97.5th percentiles from the 0 to 11 age groups. For those older than 11 years, previously published adult reference intervals validated internally with adult normal samples were used.
Conclusions:
The 2 sets of PRIs were embedded into our electronic medical record, allowing clinicians to easily interpret their patient's ROTEM results against age-verified reference ranges, enabling them to make informed transfusion decisions.
