Classical and Point-of-Care tests in severe hemorrhage management

Authors

  • Paolo Simioni Dipartimento di Medicina – DIMED, UOC di Medicina Generale a indirizzo Trombotico-Emorragico, Azienda Ospedale-Università di Padova, Padova - Italy

DOI:

https://doi.org/10.33393/ao.2022.2433

Keywords:

tbd, Hemorrhage, Hemostasis, Platelet Function Tests, Point-of-Care Systems, Thrombelastography

Abstract

 Hemorrhage is defined as an acute loss of blood from the cardiovascular system. The hemostatic cascade (comprising the vasculature, coagulation factors, the fibrinolytic and the platelet systems) is the physiological mechanism meant to control this event. Coagulation assessment is fundamental in the monitoring and treatment of hemorrhage. Over the years several classical laboratory-based diagnostic tests have been developed for the management of severe hemorrhage, however their main downside is the time necessary to obtain a result, which can be significant (between 40 minutes and an hour) and therefore not be entirely representative of a fastchanging clinical picture. Based on this need of faster results, Point-of-Care tests have been developed and implemented, since they can represent a diagnostic tool that allows a reduction of the time interval before appropriate intervention. They rely on instruments able to determine blood clot formation in whole blood samples upon activation of coagulation with specific reagents, and activation of platelets upon exposure to different drugs. The present review proposes an overview of both the available Point-of-Care tests such as Thrombelastography, for the assessment of blood clot formation, Impedance Aggregometry, for the function of platelets, and those still under improvement or missing entirely.

References

  1. Boscolo A, Spiezia L, De Cassai A, et al. Are thromboelastometric and thromboelastographic parameters associated with mortality in septic patients? A systematic review and meta-analysis. J Crit Care. 2021;61:5-13. PMID:33049490 https://doi.org/10.1016/j.jcrc.2020.09.034 PMID:33049490 DOI: https://doi.org/10.1016/j.jcrc.2020.09.034
  2. Haas T, Görlinger K, Grassetto A, et al. Thromboelastometry for guiding bleeding management of the critically ill patient: a systematic review of the literature. Minerva Anestesiol. 2014;80(12):1320-1335. PMID:24518216
  3. Spiezia L, Radu C, Marchioro P, et al. Peculiar whole blood rotation thromboelastometry (Rotem) profile in 40 sideropenic anaemia patients. Thromb Haemost. 2008;100(6):1106-1110. PMID:19132237 https://doi.org/10.1160/TH08-04-0243 PMID:19132237 DOI: https://doi.org/10.1160/TH08-04-0243
  4. Casso G, Lanzi F, Marcucci CE. Point-of-Care Platelet Function Tests. In: Marcucci CE, Schoettker P, eds. Perioperative Hemostasis: Coagulation for Anesthesiologists. Springer Berlin Heidelberg; 2015:45-63. https://doi.org/10.1007/978-3-642-55004-1_4 DOI: https://doi.org/10.1007/978-3-642-55004-1_4