Thromboelastometry (ROTEM®) in children: age-related reference ranges and correlations with standard coagulation tests

• Published in: British journal of anaesthesia : BJA Vol. 105; no. 6; pp. 827 - 835
• Main Authors: Oswald, E, Stalzer, B, Heitz, E, Weiss, M, Schmugge, M, Strasak, A, Innerhofer, P, Haas, T
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.12.2010; Oxford University Press
• Subjects: Adolescent; Aging - blood; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; blood; Blood Coagulation Tests - methods; Blood Specimen Collection - methods; blood, coagulation; Child; Child, Preschool; coagulation; Factor XIII - metabolism; Female; Fibrin - metabolism; Fibrinogen - metabolism; gender; Humans; Infant; Infant, Newborn; Male; measurement techniques; measurement techniques, thromboelastograph; Medical sciences; paediatrics; Reference Values; Reproducibility of Results; Sex Characteristics; Thrombelastography - methods; thromboelastograph; thromboelastometry; paediatrics; measurement techniques, thromboelastograph; gender; thromboelastometry; blood, coagulation; Human; measurement techniques; Measurement technique; Anesthesia; thromboelastograph; Child; blood; coagulation
• DOI: 10.1093/bja/aeq258
• ISSN: 0007-0912; 1471-6771

The small sample volume needed and the prompt availability of results make viscoelastic methods like rotational thromboelastometry (ROTEM®) attractive for monitoring coagulation in small children. However, data on reference ranges for ROTEM® parameters in children are scarce. Four hundred and seven children (ASA I and II) undergoing elective surgery were recruited for this prospective, two-centre, observational study. Subjects were grouped as follows: 0–3, 4–12, 13–24 months, 2–5, 6–10, and 11–16 yr. Study objectives were to establish age-dependent reference ranges for ROTEM® assays, analyse age dependence of parameters, and compare ROTEM® data with standard coagulation tests. Data from 359 subjects remained for final analysis. Except for extrinsically activated clot strength and lysis, parameters for ROTEM® assays were significantly different among all age groups. The most striking finding was that subjects aged 0–3 months exhibited accelerated initiation (ExTEM coagulation time: median 48 s, Q1–Q3 38–65 s; P=0.001) and propagation of coagulation (α angle: median 78o, Q1–Q3 69–84o; P<0.001) and maximum clot firmness (median 62 mm, Q1–Q3 54–74 mm), although standard plasma coagulation test results were prolonged (prothrombin time: median 13.2 s, Q1–Q3 12.6–13.6 s; activated partial thromboplastin time: median 42 s, Q1–Q3 40–46 s). Lysis indices of <85% were observed in nearly one-third of all children without increased bleeding tendency. Platelet count and fibrinogen levels correlated significantly with clot strength, and fibrinogen levels correlated with fibrin polymerization. Reference ranges for ROTEM® assays were determined for all paediatric age groups. These values will be helpful when monitoring paediatric patients and in studies of perioperative coagulation in children.