Rotational thromboelastometry and platelet indices as predictors of bleeding in thrombocytopenic patients

Abstract

Background

Thrombocytopenia is the term used to describe a subnormal platelet count (<150 × 10
3
/μl) in circulating blood. One of the most prevalent hematological conditions, it can be fatal in extreme circumstances. Reduced platelet production or enhanced peripheral platelet breakdown can cause thrombocytopenia. In patients with thrombocytopenia, increased bleeding scores or clinically severe bleeding cannot be accurately predicted by platelet count alone. The initial care of these individuals can benefit from the interpretation of platelet parameters such as mean platelet volume, platelet distribution width, and plateletcrit, as well as rotational thromboelastometry (ROTEM) parameters.



Study design and methods

This cross-sectional study was performed within the Clinical Pathology Department at Assiut University Hospitals. Subjects for the study were sourced from Internal Medicine, and Pediatrics Department. A total of 51 individuals presenting with platelet counts less than 50 × 10
3
/µl were incorporated into the study. All subjects underwent a comprehensive evaluation of platelet indices, Extrinsically activated coagulation evaluation parameters, and ROTEM platelet parameters. Additionally, a bleeding assessment was conducted employing the International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (BAT).



Results
The BAT score, along with platelet indices, particularly the Mean Platelet Volume and Plateletcrit, exhibited a statistically significant inverse correlation. Furthermore, a statistically significant inverse correlation was also observed between the ROTEM parameters and the BAT score.


Conclusion
Platelet indices, specifically mean platelet volume and plateletcrit, serve as significant tools for assessing the risk of hemorrhage in individuals with thrombocytopenia, extending beyond mere platelet count considerations.
Parameters derived from ROTEM, namely maximum clot firmness, A10, and A20, as well as ROTEM platelet measures, demonstrated considerable diagnostic efficacy in predicting bleeding events. Our research contributes essential insights into the interrelations between ROTEM parameters and platelet indices.