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Updated: Jun 2, 2026

Experimental and Imaging Techniques for Examining Fibrin Clot Structures in Normal and Diseased States
Published on: April 1, 2015
Association of fibrinogen and Rotational Thromboelastometry (ROTEM) parameters with age and race in a diverse
Marium Malik1, Maha Al-Ghafry2, Maribel Lema3
1Department of Pediatric Hematology, Oncology and Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio, USA; Department of Pediatrics, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Background:
Rotational thromboelastometry (ROTEM) is a whole-blood viscoelastic analyzer providing a global assessment of coagulation. Reference intervals (RIs) for ROTEM are limited in pediatrics, often not accounting for race. Moreover, discrete RIs may be misleading.
Objectives:
Our objective was to investigate the relationship between age (as a continuous variable) and race in ROTEM and conventional coagulation tests.
Methods:
Prospective data from 105 racially diverse pediatric subjects (aged 1-21 years) were collected. ROTEM and conventional coagulation tests (prothrombin time, activated partial thromboplastin time, and fibrinogen) were obtained. The cohort was analyzed as a whole and then stratified by race.
Results:
There was a positive association of age with fibrinogen levels (R2 = .189; P < .0001), FIBTEM amplitude at 10 minutes after clotting time (A10; R2 = .154; P = .0001), and FIBTEM maximum clot firmness (MCF; R2 = .157; P = .0001) in the entire cohort. For race stratification, only Black/African American subjects showed a negative association of age with EXTEM clot formation time, but a positive association with EXTEM/INTEM A10 and MCF (P < .001), as well as FIBTEM A10 and MCF (P < .001), revealing a propensity for a prothrombotic state in Black/African American subjects.
Conclusion:
This study reports race-specific age-related differences in fibrinogen and ROTEM, and describes ROTEM parameters as continuous variables by age. Inclusion of a diverse population in establishing race-specific pediatric RIs has clinical and public health relevance for a more accurate diagnosis and personalized treatment.
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