Standardization of Thromboelastography: Values and Challenges

ABSTRACT

Laboratory evaluation of hemostasis has been performed using plasma for several decades. The cell-based model of coagulation has now led to renewed interest in the global assays of coagulation such as thrombin generation and thromboelastography. These tests have remained as research tools, however, because of the lack of studies to demonstrate their reliability. The number of publications in the field of thromboelastography is growing daily, and many areas of clinical medicine are targeting the ability of this assay to evaluate in real time the process of coagulation and fibrin polymerization. It is clear that the methods employed by different investigators differ significantly, and therefore the results are not comparable. It is therefore critical to standardize the assay to achieve clinical relevance. This article summarizes the TEG-ROTEM Working Group's efforts to try and standardize thromboelastography and the challenges faced in this process. Although this has been the first effort to standardize this test, it is extremely important to continue this work, so that we may investigate the usefulness and possible applications of thromboelastography in evaluating the process of hemostasis.

KEYWORDS

Thromboelastography - standardization - hemostasis

REFERENCES

• 1 Salooja N, Perry D J. Thrombelastography.  Blood Coagul Fibrinolysis. 2001;  12(5) 327-337
• 2 Luddington R J. Thrombelastography/thromboelastometry.  Clin Lab Haematol. 2005;  27(2) 81-90
• 3 Spronk H M, Dielis A W, Panova-Noeva M et al.. Monitoring thrombin generation: is addition of corn trypsin inhibitor needed?.  Thromb Haemost. 2009;  101(6) 1156-1162
• 4 Dargaud Y, Negrier C. Thrombin generation testing in haemophilia comprehensive care centres.  Haemophilia. 2010;  16(2) 223-230
• 5 Mann K G, Whelihan M F, Butenas S, Orfeo T. Citrate anticoagulation and the dynamics of thrombin generation.  J Thromb Haemost. 2007;  5(10) 2055-2061
• 6 Sørensen B, Ingerslev J. Whole blood clot formation phenotypes in hemophilia A and rare coagulation disorders. Patterns of response to recombinant factor VIIa.  J Thromb Haemost. 2004;  2(1) 102-110
• 7 Kupesiz A, Rajpurkar M, Warrier I et al.. Tissue plasminogen activator induced fibrinolysis: standardization of method using thromboelastography.  Blood Coagul Fibrinolysis. 2010;  21(4) 320-324
• 8 MacDonald S, Luddington R. Critical factors contributing to the thromboelastography trace.  Semin Thromb Hemost. 2010;  36(7) 712-722