scholarly journals Reference Values of Thrombolastometry Parameters in Healthy Term Neonates

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 259
Author(s):  
Martha Theodoraki ◽  
Rozeta Sokou ◽  
Serena Valsami ◽  
Zoi Iliodromiti ◽  
Abraham Pouliakis ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Point Of Care ◽  
Delivery Mode ◽  
Reference Ranges ◽  
Term Neonates ◽  
Point Of Care Test ◽  
Α Angle ◽  
The Impact ◽  
First Time ◽  
Clot Formation Time

Background: Thromboelastometry (ROTEM), as a point of care test, is an attractive tool for rapid evaluation of hemostasis. Currently, no reference ranges exist for all ROTEM assays in neonates, limiting its use in this vulnerable population. The aim of the present study was: (1) to establish reference ranges for standard extrinsically activated (EXTEM), intrinsically activated (INTEM), and fibrinogen polymerization (FIBTEM) ROTEM assays in whole blood samples of healthy term neonates; (2) to determine the impact of gender, delivery mode, and hematocrit on ROTEM parameters. Methods: EXTEM, INTEM, and FIBTEM ROTEM assays were performed simultaneously with complete blood count in 215 healthy term neonates. Results: Reference ranges (2.5th and 97.5th percentiles) were obtained for clotting time (CT), clot formation time (CFT), α-angle, clot firmness at 10 min (A10), maximum clot firmness (MCF), and lysis index at 60 min (LI60, %). Reference ranges for EXTEM were CT 38–78 s, CFT 49–148 s, A10 40–65 mm, and MCF 47–69 mm, LI60 83–98%. For INTEM, CT 134–270 s, CFT 50–142 s, A10 41–63 mm, and MCF 48–67 mm, LI60 85–97%, and finally, for FIBTEM: CT 36–85 s, A10 9–25 mm and MCF 10–26 mm, LI60 92–100%. Hematocrit values were positively correlated with CT, CFT and negatively with A10, MCF values. Conclusion: This study provides, for the first time, reference ranges for ROTEM EXTEM/INTEM/FIBTEM values simultaneously in healthy term neonates. The combined evaluation of ROTEM tests increases its diagnostic accuracy, contributing to the expansion of ROTEM use in the neonatal population.

scholarly journals Reference Values of Thromboelastometry Parameters in Healthy Term Neonates Using NATEM in Cord Blood Samples

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 47
Author(s):  
Alma Sulaj ◽  
Marina Tsaousi ◽  
Eleni Karapati ◽  
Abraham Pouliakis ◽  
Zoi Iliodromiti ◽  
...  
Keyword(s):  
Cord Blood ◽  
Reference Group ◽  
Delivery Mode ◽  
Coagulation Disorder ◽  
Reference Ranges ◽  
Term Neonates ◽  
Blood Samples ◽  
Α Angle ◽  
Anticoagulant Medication ◽  
Clot Formation Time

Background: ROTEM assay has gained increasing acceptance as a method for rapid and specific coagulation pathway assessment. However, its use in the neonatal population remains limited since reference ranges have not yet been established. Aims: (1) to determine reference ranges for healthy term neonates of ROTEM parameters using non-activated assay (NATEM) in cord blood samples; (2) to assess whether delivery mode, gender, gestational age, birth weight and blood group (ABO and Rhesus) of the neonate, coagulation disorder and anticoagulant medication of the mother have an impact on NATEM parameters. Methods: NATEM assay was conducted in cord blood samples of 189 term neonates without any medical history. Results: Reference ranges (2.5th and 97.5th percentiles) are established for clotting time (CT), clot formation time (CFT), α-angle, clot amplitude at 5, 10 and 20 min (A5, A10, A20), maximum clot firmness (MCF), lysis index at 30 and 60 min (LI30, LI60, %) and maximum clot elasticity (MCE). Reference ranges for NATEM are CT 182–499 s, CFT 63–176 s, α-angle 58–78°, A5 28–52 mm, A10 37–61 mm, A20 42–66 mm, MCF 43–67 mm, LI30 97–100%, LI60 87–98% and MCE 75–203. Male neonates appear to be more hypocoagulable than females. Conclusions: We demonstrate reference ranges for healthy term neonates in NATEM assay that could be used as a reference group for future studies of neonates with an underlying pathology.

Coagulation Profile of Children on Extracorporeal Membrane Oxygenation (ECMO) - Is FXIII the Missing Link?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3795-3795
Author(s):  
Thorsten Haas ◽  
Carsten Doell ◽  
Markus Schmugge ◽  
Melissa M. Cushing ◽  
Vincenzo Cannizzaro
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Factor Xiii ◽  
Massive Transfusion ◽  
Complete Blood Count ◽  
Published Data ◽  
Reference Ranges ◽  
Bleeding Management ◽  
Membrane Oxygenation ◽  
Thrombotic Complications ◽  
The Impact

Abstract Background Published data about bleeding management on extracorporeal membrane oxygenation (ECMO) in children is sparse and to date no global transfusion algorithm has been established. Viscoelastic testing can be effective for determining the etiology and management of coagulopathic bleeding during cardiothoracic procedures, but data regarding its usefulness in ECMO patients are scarce. Recently, low factor XIII levels were determined to be a frequent finding in adult ECMO patients(Kalbhenn et al; Perfusion 2015;30:675-82). Methods This is a retrospective analysis of thromboelastometry (ROTEM®) and factor XIII data obtained in children (ages 0 to 18 years) undergoing ECMO since 2013 in a single center children's hospital. Acute bleeding treatment was based on daily ROTEM testing, complete blood count and routine plasmatic coagulation testing. The transfusion algorithm targeted a hemoglobin level >13g dL-1, a Quick's value >50%, a plasma fibrinogen level >1.5g L-1, and a platelet count of >100,000 µL-1. Red blood cells (RBC), solvent detergent (S/D) plasma and platelet apheresis concentrates were exclusively used to maintain hemostasis. Measurement of FXIII levels is not part of routine testing, but was assessed when unexplained bleeding was observed. Results Laboratory and transfusion data from sixteen patients, age 4 (1-15) months [median(IQR)] with a body weight of 6 (3-8) kg were included. Median time on ECMO was 7 (4-9) days. Large volumes of allogeneic blood were transfused to all children, meeting criteria for massive transfusion each individual day on ECMO (Tab.1). Overall, median daily ROTEM measurements were within reference ranges (Tab.2), while median levels of FXIII were decreased despite massive transfusion [FXIII levels 42% (28-51%)]. Conclusion Pediatric ECMO was almost always combined with daily massive transfusion, which led to correction of overall ROTEM values. Notably, despite transfusion of large amounts of plasma, decreased FXIII levels were noted. This finding is supported by results of a study in adult ECMO patients, where FXIII levels <50% were observed in 88% of all patients. Although inherited homozygous FXIII deficiency is usually defined by levels <5%, even mildly to moderately reduced FXIII levels have been reported to contribute to increased bleeding after cardiac surgery(Ternström et al; Thromb Res 2010;126:e128-33). Further studies should be performed to assess the impact of FXIII substitution in pediatric ECMO patients and to investigate whether substitution of FXIII may decrease bleeding without increasing thrombotic complications. Disclosures Haas: CSL Behring: Speakers Bureau; TEM International: Speakers Bureau; Octapharma: Consultancy.

Using a biomarker acutely to identify babies at risk of serious adverse effects from antibiotics: where is the ‘Terrible Moral and Medical Dilemma’?

2020 ◽  
pp. medethics-2020-107048
Author(s):  
Anneke M Lucassen ◽  
John Henry McDermott ◽  
William Newman
Keyword(s):  
At Risk ◽  
Adverse Effects ◽  
Point Of Care ◽  
Point Of Care Test ◽  
Pharmacogenetic Test ◽  
Loss Of Hearing ◽  
First Time

We thank Parker and Wright for engaging in this roundtable debate in such a spirited way. The ‘Pharmacogenetic [test] to Avoid Loss of Hearing’ (PALOH) Trial is the first time a genetic point of care test has been applied in the acute neonatal setting; therefore, it is not surprising that questions have been raised which require debate, discussion and clarification. Parker and Wright misattribute several assumptions to the roundtable authors, which we would like to clarify here. Since they raise wider questions about the PALOH trial itself, several of the roundtable discussants have made a joint response.

Establishing reference ranges of cord blood: point-of-care hemostatic function assessment in preterm and term neonates

2020 ◽  
Author(s):  
Marion Wiegele ◽  
Oliver Kimberger ◽  
Eva Schaden ◽  
Peter Marhofer ◽  
Andreas Baierl ◽  
...  
Keyword(s):  
Cord Blood ◽  
Point Of Care ◽  
Reference Ranges ◽  
Term Neonates ◽  
Function Assessment

scholarly journals In vitro factor XIII supplementation increases clot firmness in Rotation Thromboelastometry (ROTEM®)

2010 ◽  
Vol 104 (08) ◽  
pp. 385-391 ◽  
Author(s):  
Lars Asmis ◽  
Burkhardt Seifert ◽  
Donat Spahn ◽  
Oliver Theusinger ◽  
Werner Baulig
Keyword(s):  
Factor Xiii ◽  
Clot Formation ◽  
Intensive Care Patients ◽  
Essential Parameter ◽  
Α Angle ◽  
The Impact ◽  
Clot Formation Time ◽  
Clot Stability ◽  
Maximum Clot Firmness

SummaryFactor XIII (F XIII) is an essential parameter for final clot stability. The purpose of this study was to determine the impact of the addition of factor (F)XIII on clot stability as assessed by Rotation Thromboelastometry (ROTEM®). In 90 intensive care patients ROTEM® measurements were performed after in vitro addition of F XIII 0.32 IU, 0.63 IU, 1.25 IU and compared to diluent controls (DC; aqua injectabile) resulting in approximate F XIII concentrations of 150, 300 and 600%. Baseline measurements without any additions were also performed. The following ROTEM® parameters were measured in FIBTEM and EXTEM tests: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis (ML), maximum clot elasticity (MCE) and α-angle (αA). Additionally, laboratory values for FXIII, fibrinogen (FBG), platelets and haematocrit were contemporaneously determined. In the perioperative patient population mean FBG concentration was elevated at 5.2 g/l and mean FXIII concentration was low at 62%. The addition of FXIII led to a FBG concentration-dependent increase in MCF both in FIBTEM and EXTEM. Mean increases in MCF (FXIII vs. DC) of approximately 7 mm and 6 mm were observed in FIBTEM and EXTEM, respectively. F XIII addition also led to decreased CFT, increased αA, and reduced ML in FIBTEM and EXTEM. In vitro supplementation of FXIII to supraphysiologic levels increases maximum clot firmness, accelerates clot formation and increases clot stability in EXTEM and FIBTEM as assayed by ROTEM® in perioperative patients with high fibrinogen and low FXIII levels.

scholarly journals Dual electrochemical sensing of spiked virus and SARS-CoV-2 using natural bed-receptor (MV-gal1)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
E. Ghazizadeh ◽  
Ali Neshastehriz ◽  
Ali Dehghani Firoozabadi ◽  
Mohammad Kaji Yazdi ◽  
Esmail Saievar-Iranizad ◽  
...  
Keyword(s):  
Point Of Care ◽  
Electrochemical Sensing ◽  
Specific Detection ◽  
Early Screening ◽  
Lectin Receptor ◽  
Point Of Care Test ◽  
Viral Particles ◽  
The One ◽  
First Time ◽  
Natural Bed

AbstractIt has been necessary to use methods that can detect the specificity of a virus during virus screening. In this study, we use a dual platform to identify any spiked virus and specific SARS-CoV-2 antigen, sequentially. We introduce a natural bed-receptor surface as Microparticle Vesicle-Galactins1 (MV-gal1) with the ability of glycan binding to screen every spiked virus. MV are the native vesicles which may have the gal-1 receptor. Gal-1 is the one of lectin receptor which can bind to glycan. After dropping the MV-gal1 on the SCPE/GNP, the sensor is turned on due to the increased electrochemical exchange with [Fe(CN)6]−3/−4 probe. Dropping the viral particles of SARS-CoV-2 cause to turn off the sensor with covering the sugar bond (early screening). Then, with the addition of Au/Antibody-SARS-CoV-2 on the MV-gal1@SARS-CoV-2 Antigen, the sensor is turned on again due to the electrochemical amplifier of AuNP (specific detection).For the first time, our sensor has the capacity of screening of any spike virus, and the specific detection of COVID-19 (LOD: 4.57 × 102 copies/mL) by using the natural bed-receptor and a specific antibody in the point of care test.

scholarly journals Introduction of Cobas Liat Influenza A/B for rapid point-of-care diagnosis of influenza infection in an acute trust

2019 ◽  
Vol 20 (6) ◽  
pp. 297-300 ◽  
Author(s):  
Fran Brooke-Pearce ◽  
Elli Demertzi
Keyword(s):  
Influenza A ◽  
Positive Impact ◽  
Point Of Care ◽  
Influenza Infection ◽  
Cost Savings ◽  
Potential Cost ◽  
Bed Management ◽  
Point Of Care Test ◽  
The Impact ◽  
Acute Trust

Background: We aimed to evaluate the impact of a new molecular point-of-care test (POCT), the Cobas Liat Influenza A/B for rapid diagnosis of influenza within 20 min, on the operational workflow of the Trust, accurate diagnosis and potential cost savings during the winter of 2017–2018. Methods: A retrospective cohort study was conducted on all patients aged > 18 years tested for flu A/B by laboratory PCR in January 2017 and by POCT in January 2018. Results: From 21 December 2017 to 30 April 2018, a total of 1375 POCTs were performed with a total of 479 (35%) influenza-positive cases. Results demonstrated that 1046 (76%) suspected cases did not require isolation or were able to be discharged from Emergency Department (ED), once other risks had been ruled out. We particularly looked into the differences between the month of January 2017 (before POCT) and the month of January 2018. Discussion: Results demonstrate that influenza POCT had a positive impact on the Trust regarding prompt patient diagnosis and treatment, discharge decisions, improvement of patient bed management by avoiding unnecessary patient isolation and reducing bay closures, and significant reduction in length of stay in both positive and negative cases. Estimated cost savings were significant.

scholarly journals Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Sarah Alexandra van Blydenstein ◽  
Colin Nigel Menezes ◽  
Nicole Miller ◽  
Naomi Johnson ◽  
Bavinash Pillay ◽  
...  
Keyword(s):  
South African ◽  
Point Of Care ◽  
Anticoagulation Therapy ◽  
Maximum Amplitude ◽  
African Population ◽  
South African Population ◽  
Point Of Care Test ◽  
Black Patients ◽  
Definition Of ◽  
Α Angle

Introduction. The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient. Methods. A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (n = 26) were women. The median age was 61 (IQR 50–67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18–30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46–0.62), whilst 29/41 (0.71, CI 0.64–0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower ( p  ˂ 0,01), and the α-angle ( p  ˂ 0,01) and maximum amplitude (MA) ( p  ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively. Conclusions. In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.

scholarly journals Harmony COVID-19: a ready-to-use kit, low-cost detector, and smartphone app for point-of-care SARS-CoV-2 RNA detection

2021 ◽  
Author(s):  
Nuttada Panpradist ◽  
Enos Kline ◽  
Robert G Atkinson ◽  
Michael Roller ◽  
Qin Wang ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Point Of Care ◽  
Low Cost ◽  
High Viral Load ◽  
Respiratory Pathogens ◽  
Rna Detection ◽  
Point Of Care Test ◽  
Viral Transport ◽  
Viral Particles ◽  
First Time

RNA amplification tests sensitively detect SARS-CoV-2 infection, but their complexity and cost are prohibitive for expanding COVID-19 testing. We developed Harmony COVID-19, a point-of-care test using inexpensive consumables, ready-to-use reagents, and a simple device accommodating up to 4 samples simultaneously. Our ready-to-use, 4-plex reverse-transcription, loop-mediated isothermal amplification (RT-LAMP) can detect down to 0.38 SARS-CoV-2 RNA copies/μL and can report in 17 min for high viral load samples (5,000 copies/μL). Harmony detected 97% or 83% of contrived samples with ≥0.5 viral particles/μL in nasal matrix or saliva, respectively. Evaluation in clinical nasal specimens in viral transport media (VTM, n=101) showed 100% detection of RNA extracted from specimens with ≥0.5 SARS-CoV-2 RNA copies/μL, with 100% specificity in specimens positive for other respiratory pathogens. VTM is non-ideal for Harmony system, yet extraction-free analysis of VTM specimens (n=29) had 95% success in specimens with ≥1 RNA copies/μL. Usability testing performed first-time by healthcare workers showed 95% accuracy

scholarly journals Pharmacogenetics to Avoid Loss of Hearing (PALOH) trial: a protocol for a prospective observational implementation trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044457
Author(s):  
John Henry McDermott ◽  
Rachel Mahood ◽  
Duncan Stoddard ◽  
Ajit Mahaveer ◽  
Mark A Turner ◽  
...  
Keyword(s):  
Clinical Pathways ◽  
Point Of Care ◽  
Secondary Outcome ◽  
Buccal Swab ◽  
Routine Practice ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Point Of Care Test ◽  
First Choice ◽  
The Impact

IntroductionIn conjunction with a beta-lactam, aminoglycosides are the first-choice antibiotic for empirical treatment of sepsis in the neonatal period. The m.1555A>G variant predisposes to ototoxicity after aminoglycoside administration and has a prevalence of 1 in 500. Current genetic testing can take over 24 hours, an unacceptable delay in the acute setting. This prospective-observational trial will implement a rapid point of care test (POCT), facilitating tailored antibiotic prescribing to avoid hearing loss.Methods and analysisThe genedrive POCT can detect the m.1555A>G variant in 26 min from buccal swab. This system will be integrated into the clinical pathways at two large UK neonatal centres over a minimum 6-month period. The primary outcome is the number of neonates successfully tested for the variant out of all babies prescribed antibiotics. As a secondary outcome, clinical timings will be compared with data collected prior to implementation, measuring the impact on routine practice.Ethics and disseminationApproval for the trial was granted by the Research Ethics Committee (REC) and Human Research Authority in August 2019. Results will be published in full on completion of the study.Trial registration numberISRCTN13704894.Protocol versionV 1.3.

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