Establishment of the Normal Reference Range of Thrombelasto-gram among the Healthy Population and Pregnants in China

  • Rong GUI The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Xueyuan HUANG The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Ming ZHOU Department of Hematology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
  • Shujuan OUYANG The Hunan Cancer Hospital, Changsha, Hunan , China
  • Yunfeng FU The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Hao TANG The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Fengxia LIU The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Rong HUANG The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Meng GAO The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Hang DONG The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Yongjun WANG The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Keywords: Thrombelastogram; Normal reference range; Healthy volunteers; Pregnant women; China

Abstract

Abstract Background: We aimed to establish the reference range of thrombelastogram (TEG) for Chinese healthy volunteers and pregnant women and analyze the influence factors. Methods: Blood samples were collected from healthy volunteers and pregnant women at five tertiary hospitals (the Third Xiangya Hospital of Central South University, the Second Xiangya Hospital of Central South University, Hunan Provincial People's Hospital, Hunan Cancer Hospital and Changsha Central Hospital) in 2016. The effects of age, gender, blood type, and full-term pregnancy on the reference range of normal TEG for healthy volunteers and pregnant women were studied. The specificity of TEG in detecting coagulation disorder. Results: For healthy volunteers, the normal ranges of TEG parameters were as follows: R, 4.3-9.3 min; K, 1.2-3.2 min; α, 50.2-71.2°; MA, 54.1-71.3 mm; LY30: 0%-2.2%; CI, -3.8-2.4. At least one parameter exceeded the normal range specified by the manufacturer in 20.3% of the healthy volunteers; about 7.6% healthy volunteers were diagnosed as coagulation disorder by the above standards; the specificity of detection was 79.7%. There were significant differences in R, K, α, MA and CI between males and females (P<0.01). For pregnant women, the normal ranges of TEG were as follows: R, 3.9-7.5 min; K, 1.0-2.4 min; α, 57.6-74.9°; MA, 55.7-75.7 mm; LY30, 0%-0.56%; CI, -0.97-3.6. Pregnant women having O blood group had a dramatically prolonged R. Full-term pregnancy had no significant impact on TEG results. Conclusion: Compared with pregnant women having non-O blood group, those having O blood group had a dramatically prolonged R and showed greater tendency to hemorrhage during and after parturition.    

References

1. Sun W, Jeleniowski K, Zhao X, Shen PU, Hammond J (2014). Thromboelas-tography (TEG)-based algorithm reduces blood product utilization in patients un-dergoing VAD implant. J Card Surg, 29(2): 238-43.
2. Afshari A, Wikkelo A, Brok J, Moller AM, Wetterslev J (2011). Thrombelastography (TEG) or thromboelastometry (ROTEM) to monitor haemotherapy versus usual care in patients with massive transfusion. Cochrane Database of Syst Rev, 66: CD007871.
3. Wang SC, Shieh JF, Chang KY, et al Tsou MY (2010). Thromboelastography-guided Trasfusion decreases intraopera-tive blood transfusion during oflhotopic liver transplantation: randomized clinical trial. Transplant Proe, 42(7): 2590-3.
4. Subramanian A, Albert V, Saxena R, Agrawal D, Pandey RM (2014). Establishing a normal reference range for thromboelas-tography in North Indian healthy volun-teers. Indian J Pathol Microbiol, 57(1): 43-50.
5. Ji HW, Ma L, Gao XR, et al (2011). [Estab-lishment of normal reference values for thromboelastography on Chinese popu-lation in Beijing]. Zhonghua Yi Xue Za Zhi, 91(14): 980-3 [Article in Chinese].
6. Scarpelini S, Rhind SG, Nascimento B, et al (2009). Normal range values for throm-boelastography in healthy adult volun-teers. Braz J Med Biol Res, 42(12): 1210-7.
7. Maiello M, Torella M, Caserta L, et al (2006). [Hypercoagulability during pregnancy: ev-idence for a thrombophilic state]. Minerva Ginecol, 58(5): 417-22 [Article in Italian].
8. Thornton P, Douglas J (2010). Coagulation in pregnancy. Best Pract Res Clin Obstet Gy-naecol, 24(3): 339-52.
9. Polak F, Kolnikova I, Lips M, Parizek A, Blaha J, Stritesky M (2011). New recom-mendations for thromboelastography reference ranges for pregnant women. Thromb Res, 128(4): e14-17.
10. Macafee B, Campbell JP, Ashpole K, Cox M, Matthey F, Acton L, Yentis SM (2012). Reference ranges for thromboe-lastography (TEG®) and traditional co-agulation tests in term parturients under-going caesarean section under spinal an-aesthesia. Anaesthesia, 67(7): 741-7.
11. Watson HG (2005). Thromboelastography should be available in every labor ward. Int J Obstet Anesth, 14(4): 325-7.
12. Drukker L, Srebnik N, Elstein D, Levitt L, Samueloff A, Farkash R, Granovsk SG, Sela HY (2016). The association between ABO blood group and obstetric hemor-rhage. J Thromb Thrombolysis, 42(3): 340-5.
13. Karlsson O, Sporrong T, Hillarp A, Jepps-son A, Hellgren M (2012). Prospective longitudinal study of Thromboelas-tography and standard hemostatic la-boratory tests in healthy women during normal pregnancy. Anesth Analg, 115(4): 890-8.
14. Kaufmann CR, Dwyer KM, Crews JD, Dols S, Trask AL (1997). Usefulness of thrombelastography in assessment of trauma patient coagulation. J Trauma, 42(4): 716-20.
15. Chan KL, Summerhayes RG, Ignjatovic V, Horton S, Monagle PT (2007). Reference values for kaolin-activated thromboelas-tography in healthy children. Anesth Analg, 105(6): 1610-3.
16. Ellis TC, Nielsen VG, Marques MB, Kirklin JK (2007). Thromboeiastographie measures of clot propagation: a compari-son of alpha with the maximum rate of thrombus generation. Blood Coagul Fibrinol-ysis, 18(1): 45-8.
17. Sun JB, Bian MH, Zhong T, Lu YY, Zhu BQ, Wen HQ, Hu HL (2017). Reference values for kaolin- activated thromboelas-tography in volunteers of Anhui Province in China. J Clin Lab Anal, 31(6). doi: 10.1002/jcla.22128.
18. Coolman M, de Groot CJ, Steegers EA, et al (2006). Concentrations of plasminogen activators and their inhibitors in blood preconceptionally, during and after preg-nancy. Eur J Obstet Gynecol Reprod Biol, 128(1-2): 22-8.
19. Saha P, Stott D, Atalla R (2009). Haemostatic changes in the puerperium ´6weeks po-spartum´ (HIP STUDY)-implication for maternal thromboembolism. BJOG, 116(12): 1602-12.
20. Rasmussen KC, Højskov M, Johansson PI, et al (2016). Impact of Albumin on Coagulation Competence and Hemor-rhage During Major Surgery:A Random-ized Controlled Trial. Medicine (Baltimore), 95(9): e2720.
21. Da Luz LT, Nascimento B, Shankarakutty AK, Rizoli S, Adhikari NK (2014). Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopa-thy, transfusion guidance and mortality in trauma: descriptive systematic review. Crit Care, 18(5): 518.
22. Holli Halset J, Hanssen SW, Espinosa A, Klepstad P (2015). Tromboelastography: variability and relation to conventional coagulation test in non-bleeding intensive care unit patients. BMC Anesthesiol, 15:28.
23. Beilin Y, Arnold I, Hossain S (2006). Evalu-tion of the platelet function analyzer(PFA-100) vs. the thromboelastogram (TEG) in the parturient. Int J Obstet Anesth, 15(1): 7-12.
Published
2019-05-14
How to Cite
1.
GUI R, HUANG X, ZHOU M, OUYANG S, FU Y, TANG H, LIU F, HUANG R, GAO M, DONG H, WANG Y. Establishment of the Normal Reference Range of Thrombelasto-gram among the Healthy Population and Pregnants in China. Iran J Public Health. 48(5):841-848.
Section
Original Article(s)